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s <br /> � � �-� / � <br /> ! everett i��` � .,ra' I CHART NO.� � - =' t - `� _ <br /> ' '' � — <br /> �1 � �" -. . .f^' �'� �'. `l .. <br /> y!� _� <br /> i <br /> City oi Everett <br /> '• Engineering & Conimunity Servicc: <br /> � <br /> j Sewer ��pplication and Permit <br /> � <br /> � <br /> I N0. ;• '_ ?� !� i DATE %�//��7 _ � <br /> ServiceAddress_JO ..< /1 y /j ' F/7/rG�;,4 UtilityAccountNo._..3 - ; l -/ y/-O/ <br /> Billingl�ddress_���7�I.Q yYT� �. � �� <br /> I -- Permit Fee_ �O <br /> �v.� �✓• ou �= <br /> City, State, 2i � �(/�_ `/,I�C�6 Connection Charge(s) �'�'O <br /> Owner (Mortgagod�.�- . v��/c i � �1i.�.�.� < /fi 3�) �� <br /> _S, Total Fee_ <br /> Billing Name__-�� M� <br /> Connection By_ -�f� /N E <br /> Address `. /Cn ./� � � �,� <br /> Signed r�,�: �� 2 i C' <br /> I Phone�.�yS "� ��� Cuvomer <br /> � <br /> DESCRIPTION: <br /> I � .1\ Sewer District 3 J <br /> ! Lot��___ g�ock �� <br /> ! Plat �f. . t.�` i� MonthlySewerService <br /> ' Unplatted Description Monthly Sewer Constr. <br /> I <br /> Type Permit: �f� r ��y Trunk �, ,=:J � <br /> t'L Y <br /> Lateral <br /> Remarks: <br /> Aoutting Lot Line <br /> —" _. N, S, E, W - ft. <br /> � — <br /> APproved By �'� '' �-/ ` � � - <br /> CnV Enpineer <br /> ' / <br /> �'tiUC(I B � � ' <br /> Y---- — <br /> � — <br /> i _ ��-- <br /> � Inspection By__ � <br /> — ----------.-. —'�_ -i?L[r—c�_.__-- <br /> � . _____._ ._—_._ <br /> __ <br /> � o ----�� �f�--- J Date Inspected�/� � <br /> --- -- - � ----— <br /> i SEE SKETCH ATTACHED N� <br /> ; � � , i ; iu <br /> � <br />