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CHART NO._ <br /> everett <br /> e <br /> I City of Ererett <br /> Sewer Application and Permit <br /> No. 25209 DATE ��Q�f <br /> � <br /> Service Address,�y2�� � � Utility Account No. <br /> Billing Addressf�3I l <br /> � Permit Fee � �� <br /> City,State, Zip Y � 0 Connection Chargels) <br /> Owner (Mortgagor) -,��--f-ic,r��t��� Total Fee a � — <br /> ✓ <br /> Billing Name <br /> Connection BY ,��� � J / i r !�/�/ ��� �, <br /> � I <br /> Address � �• Signed_T, ' <br /> �. �O cuslomer <br /> Phone G G <br /> pf�iGRIPTION: <br /> �.af' � Sewer District <br /> �„'" � 9 �o�k <br /> � Monthly Sewer Service <br /> Plat • --� <br /> Unplatted Descript' n Monthly Sewer Constr. <br /> Trunk <br /> Type Pcrmit: - o' <br /> Lateral <br /> � - <br /> Remarks: Abutting Lot Line <br /> N S, E. W ft. <br /> Approved By /� •�- ��� <br /> Ciry En9inex <br /> Issued By � '�"' � <br /> Inspection By-�" v"�"""� <br /> Date Inspected �— 3 ^� <br /> SEE SKETCH ATTACHED N�� 2�7� <br /> INSPECTION <br />