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i CHART NO. '� � � <br /> � evcrett /.J� S ✓ �"� <br /> ' "� / - 9 - 78� <br /> 1i City of Everett � <br /> � Enpineering & Community Services I • <br /> �. Sewer Application and Permit � <br /> � � _ <br /> IN0. DATE ;"/ i''-� i' � -- --- -- - <br /> I _ 1'. . ;�� _( .i <br /> � Seruice Address � ' ' � ---=—� Utility Account No. - <br /> i <br /> t _ <br /> � f Permit Fee <br /> Bili ng Address_ ._._-- <br /> --/ f _ / Connection Chargels) ' � �� <br /> f City, State, Zip ' .�.- <br /> I� Owner (Mortgagor) i Total Fee ' � <br /> ' / <br /> Billing Name — ' <br /> � <br /> � �_ ', _�� � <br /> � / `. <br /> , <br /> � Connection By � � , '�.��G� <br /> it. . � � � <br /> r '`- �- <br /> j Signed / � <br /> Address uswm«r <br /> Phone �� '=�'--- �- <br /> � Sewer District_ � L� — <br /> i DESCRIPTION: <br /> � Lot f� Block_� - Alonthly Sewer Service �` � <br /> i <br /> � Plat ---- �� <br /> � _ Monthly Sewer Constr. <br /> Unplatted Description_ <br /> � Trunk - ����—' `� --- <br /> I — �J . <br /> i TYPe Permit: 7 Lateral , y�J c � <br /> Remarke: Abutting Lot Line <br /> N, S, F, W- - it. <br /> AppfOVBd BY CnY Engmeer <br /> — Issued By ----- '--fi-- <br /> c' . <br /> Inspection By�� {CG_-� -_- <br /> _ �_.»__�-- <br /> ___ j � ��0 7 <br /> -- -� Date Inspected_ -�--- <br /> �' -- -- - �_ . ---- <br /> 0 � NO. <br /> � SEE SKETCH 1TAE}'fEb <br /> `�"�"� � <br /> � r <br /> wt ,,:� y "�T...ti ,.. <br /> .v. . � r-ia. :Y�.H ! . . . . . . <br />