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cverett CHART NO.______ __ <br /> I � O,� / <br /> � � , <br /> � City of Everett G —G , �S <br /> I <br /> Sewer Application and Permit � ���3 i <br /> I <br /> � <br /> NO. Z311Z DATE ------ I <br /> _._ _._`— _ i <br /> Service Address__ �— <br /> I ---- ----- - Utility Account No. —_ <br /> Billing Addr�ss <br /> ,� <br /> , ��- Permit Fee '/ , ��'J <br /> City, State, 2iP_ I, � ! r ,� �. <br /> /. <br /> _ Connection Charge(sl_ � <br /> Owner (Mortgagor� �, <br /> � Total Fee i: . <br /> Billing Name_�� ; � <br /> � , <br /> i <br /> i Connection By + , <br /> _' <br /> ; Address ' - <br /> I -- — � �. !i : i_ ,.� /- <br /> . �. Signed <br /> Phone_ i � " ` � <br /> cu:�omer <br /> I DESCRIPTION: <br /> � Sewer District__ <br /> Lot_�_ glock__�_ <br /> Plat -------- <br /> I � �' ,_. Monthly Sewer Service _ <br /> Unplatted Description—_ --___ <br /> I r: , - - ---- Monthly Sewer Constr, <br /> r <br /> Type Permi[: ___ <br /> Trunk <br /> I \ \- ' � _ <br /> i <br /> Remarks: Lateral <br /> ; -- Abuttmy Lot Line i <br /> "� i N, S, E, W_'------- i <br /> _ft. <br /> —'-- <br /> -- Approved By � i r� ' , �. � , , <br /> — Ci1y Enpinew . <br /> — is5��edoy /_ �_, r ' ���.� � , � <br /> ------ <br /> I - <br /> I ------------- Inspection 8 —�� , / � <br /> �----- _ __. Y_._��'�`ca�-_VIJ� , C� <br /> I ----- <br /> — Date Inspected J ' 1 2 • 7�) <br /> SEE SKETCH ATTACHED -- <br /> ; No 23iiz <br />