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I <br /> CHART N0.— <br /> everett <br /> e � <br /> � <br /> City of Everott � � ,R �TS � $ 'u� $ � <br /> '= �. �' : «a. "` 'n . . <br /> � w ni- <br /> M M v <br /> • • ' "' [ � Y � i� � <br /> Sewer Applicat�on and�,���t� � � � � ` � � : ,_ <br /> 2596T a .]] ... � � a: � t� c � u'ts � � <br /> NO. DATE rorra'�� 17�,19e6 <br /> Service Address >>l� $ro�dvat _ Utility Account No. <br /> Billing Address Permit Fee � Z 50 <br /> City,State, Zip t�►Lr.tt xA 9B2oi Connection Chargels) <br /> Owner (Mortgayor) Jadc �ath Total Fee � �+ <br /> Billing Name �� ��*b <br /> Connection By ��� o�ti*�+^^ h+ <br /> Address p o � 1209 �s.�. c o ��u Signed _ - <br /> 1��, <br /> Phone z�-'+�� <br /> DESCRIPTION: Sewer District <br /> Lot e Block ?96 <br /> Monthly Sewer Service <br /> Plat <br /> Unplatted Description � � Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: � �SDC Lr[�v5 <br /> Abutting Lot Line <br /> -��— - N g, E, y� ft. <br /> � � <br /> i t• t L-yh <br /> Approved By <br /> nv oginen <br /> IMPORTANT! <br /> Issued By �r7�! F.. McLtoa <br /> CALL 1-800-024-5555 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 2595811 FOF INSPECTION <br /> Inspection By_.— — <br /> Date Inspected <br /> SEE SKETCH ATTACHED NO. 2J96� <br /> If�'�PEC I IOIV <br />