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I <br /> CHART NU. <br /> everen N ��-Zs-s I <br /> � t '� <br /> "��j/ C� � <br /> City of Everett / Z �'��� <br /> �� <br /> Sewer Application and Permit 9� <br /> N0. �317p DATE . %� <br /> �v� � , . <br /> Service Address �— Utility Account No. <br /> Billing Address f Permit Fee �_ <br /> City, State, Zip Connection Charge(s) <br /> Owner (Mortgagor) Total Fee -- - <br /> Billing Name <br /> .- � <br /> Connection By I <br /> � ` � <br /> Address Signed_ _ �="' � ��'� � <br /> CustoMtr <br /> Phone � <br /> CESCRIPTION: Sewer District <br /> Lot Block <br /> Plat Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: _ Trunk <br /> Lateral <br /> Remarks - <br /> � Abuttin, Lot Line <br /> �; � .il, /� .,.� is" �i,i N, S, E, 1A� ft. <br /> ,Z � % c �iT /''�c .c..-,� �.,�.� <br /> /;r: /lN</-�c� Z f�Ci ..� � .Y C./-,. . ./ _/ <br /> Approved By_ � <br /> �i/'C: C�ry Engincer I <br /> Issued By f <br /> Inspection By y� .� -�`�'` %'`�� <br /> Date I nspected /f�j�71� � <br /> SEE SKE'fCH ATTACHED Np. Z317S <br /> INSPfCTI�I� � <br />