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I , CHART �0.��•� - ? ` - � <br /> I everetl ;�. <> ,T� <br /> i , . <br /> ' e ,>« �� , ., . , <br /> i <br /> � City of Everett <br /> I Engineering & Community Services <br /> I Sewer Application and Permit '� <br /> � , , <br /> i N0. ,' ' ; ; � i D 4TE / �' � � — --------- - ---- — - <br /> IService Address � � � Utility Account No._—_—.-- ---- <br /> � <br /> j �-+ �� ��. <br /> Billing Address �L'!' ��' 'r " " `� 3 Permit Fee ��'� <br /> � � . �'� ,-GU� • �h�--� UJ Connection Charge�s) <br /> iCity, State, Zip � <br /> � � ,- . - Ci � :!%�.:rf, .. ✓ TotalFne_._/�)- ---- <br /> f <br /> Owner (Mortgagor) <br /> ` Billing Name �-� <br /> IConnection 8�,• - - �-1 <br /> I Signed �' — `' <br /> Address c�:io�n�� <br /> ' Phone l ;' � - l' j G .:� -- <br /> DESCRIPTION: Sewer District___ _ ..__ ._ ___.___-- <br /> � Lot _ Block Monthly Sewer Service _ <br /> � Plat <br /> � Unplatted Description�.' � . �� -='�___t_�—�Monthly Sewer Constr. <br /> � � Trunk , <br /> Type PermiU � . . ,� <br /> � �ateral <br /> I <br /> � Remarks: <br /> � Abutling Lot Line <br /> I -- N, S, E, �y ft. <br /> I <br /> i <br /> i / <br /> -- Appruved By� • �f <br /> , Cny Engmcer , <br /> � <br /> ' Issued By•' _-_ <br /> 7 C <br /> . Inspection By—�`.'�3 2 -��� <br /> _ _ Datelnspected 7����� - <br /> , o — � <br /> � SE[ SKETCH ATTACHED NO. <br />