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I <br /> everett CHART N0. `�r-�i�-7 <br /> � � � � ' . <br /> �"oS�O , , <br /> c�ri o; e,�e�ett <br /> Engineerinp & Community Services � � � - �7� <br /> Sewer Application and Permit �1� <br /> ; , � <br /> N0. �� ( � :� 1 DATE ,-;'i �/j,,- <br /> . <br /> 7SZS G� �j�GN L�� <br /> Service Address �-y ^-' .11tAity Account Na. 1- `X' ����-U U <br /> .i <br /> Billing Address � / " ' � �/ �-' Permit Fee <br /> � :..- <br /> City, State, Zip �� v "✓ ` Connectior Charge�s) � ' _ <br /> Owner (Mortgagnr) �' - � _ � Total Fee _ � <br /> Billing Name ---' <br /> Connection By_ - __ t <br /> .4ddress_. _ Signed. � <br /> Pho�e <br /> �s 5 � - lJ �, =. �� r.��:���� <br /> DESCRIPTION: Sewer Distrir.t � � � <br /> Lot_ ^ � Block_ _ <br /> Plat ,, Monthly Sewer Service <br /> Unplatted Description ___ Monthly Sewer Constr. <br /> .. <br /> Type Permit: � <br /> — Trunk �� � '� �`'" ' <br /> ' ' Lateral �� <br /> Rer tarkt: <br /> - Abutting Lot Line <br /> ---- - N, S, E, W tt. <br /> ,i . <br /> — — Approved By . � -'- - . .. <br /> CnV Enqinrer <br /> Issued Bv � ' '-=_-� _ <br /> __ _ Inspection B`�«������'G�� <br /> ----- f <br /> o---------. --- --------- Datelnspected �/ � + <br /> i <br /> SEESKETCH ATTACHED N0. � <br /> � ' ! I ' <br /> �. <br />