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, <br /> �y - <br /> CHART N0. �—� �/—�"" S — <br /> everett � �„/ <br /> e 8.�,�.Y. <br /> �_�� <br /> c�ey or e�erett � <br /> Sew�r Application and Permit <br /> � <br /> No. 23173 DATF? �; - � — — <br /> � �,, ,g /r�[3 -, <br /> Service Address_���(�.�' Utility Account No. _— <br /> Billing Address � � Permit Pee �/ <br /> City, State, 2ip_ % - Connectio� Chargels) <br /> Owner (Mortgagor) Total Fee 1 ' <br /> Billi�g Name <br /> .. -- . � <br /> Connection By_ � �-' �� <br /> Address Signed _ ,Jii; ��•'%' i <br /> � .:y�� cualamer <br /> Phone — � <br /> DESCRIPTION: Sewer District_ �--__ <br /> Lot � Block <br /> Monthly Sewer Service __ <br /> Plat _ <br /> Unplatted Description Monthly Sewer C;anstr. <br /> , -- Trunk � <br /> Type Perinit: � <br /> —� Lateral <br /> Remarks: <br /> _ Abutting Lot Line <br /> N, S, E, W _ _ f[. <br /> .�_l1� AM� _ _ I �icl-1 f}S <br /> Approved BY-- — <br /> City EnOmeer <br /> --n <br /> �—� I <br /> Issued By_ � <br /> _- _ _-.-_ --_--- , � � � ; <br /> ____ ___ InspPction By_�_=`��'`'`' I <br /> Date Inspected_ � �S ^ <br /> SEE SKETCH ATTACHED No� 23173 <br /> INSP[CTION <br /> 1 <br /> � <br />