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CHART NO. <br /> evereft <br /> e ' � <br /> City of Everett <br /> '�''�%r, fl1E'.'��, <br /> Sewer Application and Permit -� ��:1� „n;- � - <br /> No. 23895 DATE %'///� ' <br /> Service Address %� �� ' � f � � � Utility Account No. <br /> Billing Address�" ' � r- ' Permit Fee � � <br /> City, State, Zip ' i , . � � -�f/' - Connection Charge�s) <br /> Owner (Mortgagor) � - � -Total Fee %=� " <br /> Billing Name- � � <br /> Connection By_ _ ' , <br /> ` �/•� <br /> Address � Signed� ��..-<•. _ � r� ���_ � <br /> i% Customer <br /> Phone- '� <br /> i <br /> DESCRIPTION: Sewer District <br /> Lot .=� 1 T Block '� =�( <br /> Plat _ _ . . � ; . ; : �t'_ <br /> Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> .••� �, <br /> Lateral <br /> Remarks: <br /> -/ Abutting Lot Line <br /> /�+ � L!J 6 2C— ��CJ N, S, E, W ft. <br /> � (3 <br /> Approved By %`� /. � , �_ �•• <br /> Ciry Enpineer <br /> Issued By � { • ; ! t � �/ r:1.�a <br /> Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED NO. 23895 <br /> INSPECTION <br />