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� <br /> � CHART NO.��� � ����' ���� � <br /> eve�ed � ��Tti'T1R/ITa � /�� � / `r'o ', <br /> � i <br /> • "` l,U � ] � t?�B //— 30 - �7 g <br /> � � <br /> City of Everett �--.... ---- 7 L '•� I <br /> Gngineering & Communiry Serv�ces CITY 0' =bERETT �N��- i <br /> Fn;;r <<:rint' Dep�. <br /> Sewer Ap�asitcition and Permit � i <br /> � <br /> C, � � � �_: + <br /> N0. t'' L .� I � DATE � <br /> I <br /> Service Address `� � � 1 -� ' '� t:=�'����� ��-= Utility Account No.% " ���" j, �'' � �V i <br /> � •'J <br /> {�.n �✓a_ �' I I �--' Permit Fee ���_' ; <br /> Billing Address - <br /> �'- v - !.a ��(� C.)(,J I <br /> City, State Zip t--�-�` �-� r ` '�` � G� - Connection Chargelsl— � <br /> � -� O. � <� i <br /> Owner (Murtgagor�Lr' �- � '�"' �'-'I� G `- I �-� C Total Fee___ -" _ --- I <br /> . <br /> ���_)L i �J I� ✓ C•. I ti,� � <br /> Billing Name_ _. — <br /> , � ti..� C, I <br /> Connectinn By�' �- ` 'L'' ' -' �� �' ' - !'I � I <br /> � .�'_1��.� ��,� , <br /> Address� C� �'-�� �_ ( � ' :, _ Signed <br /> cusmmer <br /> � . ` . ` ��,� .:, � <br /> Phone -' -- ---- — <br /> DESCR I PTI ON: <br /> Sewer District �` �'� '—' '� -L — { <br /> Lot_�-= Blocr '� �- L� i <br /> \ ,IZ—�'�i `� i���� �-K MonthlySewerService — � <br /> Plat 1 i �'%�. � •+� � , 1\< <br /> Unplatted Description —Monthiy Sewer Constr. , <br /> (_._ i>'T l - 1 [--C'1 - � l�- "7 � p . 'Z. l� <br /> Trunk <br /> Type Permit: �C_w L,C n� ti1E� '7' • �'ev <br /> — Lateral [� • � �--' _ <br /> Remarks: �.-� Abutting Lot Line <br /> N� S• E� W- -- ft. <br /> ---- + <br /> — r � � <br /> — APProved ByL I'_�1��_) �✓ � �u , <br /> Ciry E�pincer <br /> _ Issued By. � �- �� �. ,_ �1 I r,�h�l_/ <br /> _ -- — / / i <br /> �------�--------- Inspection E3y_���_�.L�k�� ' - 1 <br /> i � <br /> —---- I <br /> ------ <br /> Date I nspected -�'f �7� _.�--��-�-- <br /> 9—� .._.__----. . — �� --'- <br /> SEE SKETCH ATTf\CHED NO. , <br /> ����� I <br />