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I <br /> ; CHART NO.� ��' " ' � ' " <br /> everetl '' <br /> � � <br /> ; e �'�% ,_ : � <br /> � ��z�� . , <br /> � City of Evarett /1 ^ � <br /> Engineering & Community Services �ti <br /> I <br /> ! Sewer Application and Permit �� � � <br /> � ; . i <br /> N0. � ,' < <. '� ! DATE ���� ��� / �' I <br /> i �- ` �'..5 <br /> IService Address r'�-J I � � -. � �-> • � Utility Account No. � � <br /> � • � �'% <br /> � BillingAddress �^�_i./ �� v ��� �/,-` . ;: • PermitFee �� <br /> �. <br /> � City,State, Zip� � !L, -%t . /J'"�'i! � Connection Charge(s�_ y%O ! I <br /> ! Owner (Mortgagor)L�_�� _ _� Total Fee_,�U ^' � <br /> ; Billing Name �--� _ i <br /> � <br /> � Connection By_� � . +"� � ,' <br /> i <br /> � Address Signed j��L���^ f'�� <br /> � custortror j <br /> � Phone -� ! / ---=�3 _— ' <br /> . : �� <br /> DESCRIPTION: Sewer District��2� � l�- .� Z I <br /> Lot Block__ � <br /> ` Plat Monthly Sewer Service .� � i <br /> � Unplatted Description.�.�. �- U '� � � ',L Monthly Sewer Constr. � <br /> ( <br /> � Type Permir. , / . Trunk_ r�. �U <br /> ��..: J <br /> � Lateral >> • / O <br /> ' Remarks: -- - <br /> Abucting Lot Lipe <br /> N, S, E� � U ft �, <br /> I <br /> � _ . �i ' � <br /> j Approved By �L � <br /> ciry Enu.r-er . <br /> � � i <br /> � Issued By <br /> - � <br /> Inspection By � � <br /> ,_-' � - � <br /> Date Inspected. �' ' ? r� � 7�� <br /> Y <br /> 1 <br /> SEESKETCH ATTACHED NO. , <br /> � �oi��� , ; <br /> i <br />