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� everetl I CHART �VO. ' � � S <br /> / � . <br /> —_S�'_--------- <br /> � � <br /> � � %S �` � <br /> ICity of Everett <br /> .s Z%-S. <br /> Sewer Application r�nd PQrmit �/.3 � <br /> � <br /> NO. Z3116 DATE __ ' ---: ----- I , <br /> Service Address <br /> L-- - <br /> ---� Utility Account No. <br /> Bi'ling Address � <br /> — __ Permit Fee <br /> I CitY, State, Zip — ---� - -- . <br /> Connection Charge(s�_ <br /> � Owner (Mortgaqor�_ <br /> � — --_ Totai Fee____ <br /> i i E3illing Name_ --- <br /> --�'— -- <br /> IConnection By __ -�-.�—__ <br /> I Addiess � . <br /> , -----_'_-- `�igned_ ..- ._�_� ; � � <br /> i Phone_ a��rom�, <br /> ! GESCRIPTION: <br /> � Sewer District__ <br /> � Lot--- Block--- ---- <br /> i P��t — __ Monthly Sewer Service___ ____ <br /> �--- <br /> Unplatted Description______ <br /> � --------__ Momhly Sewer Constr. <br /> i — <br /> iType Permit: -' Trunk <br /> � �---- <br /> Remarks: Lateral <br /> � —. -----_--__ <br /> � _ Abutting Lot Line � <br /> j N, S, E, W_----- <br /> - ft. <br /> I � �''� � �� <br /> I F <br /> '1•�Y�' A/ir�i / 11 u� I <br /> i - " �r-. �� AUProved By_�_ — --- -- <br /> .���� "� .� • CiIY Engineer <br /> � .�--__��`�_Y'Dl/� L� q���_.!_ <br /> i --[/�1zr- „y, n , V IssuedBy _--- 1, <br /> / ---�_ <br /> i -_��,..,. ' ,�y �______�,,,c _,C�� -- � <br /> � <br /> ----_- <br /> —" ----- - -- ---- Inspection By�I�l[!n_.__[��/f�,1. ?L� <br /> I — — _ _ Date Inspec[ed__ -� � � <br /> _ _ __2 l -1_� -- --- <br /> I SEE SKETCH ATTACHED NO z3j,1,Cj <br />�_— <br />