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CHART N0. �y � � <br /> everett � , • � <br /> � � ` .5 ��� % <br /> - -, c' - <br /> City of rverett _S �- I s <br /> � <br /> ��} <br /> Sew�er Application cn�l Permrt ' ,� <br /> N0. ZZ9,A.q��Z. DATE __ � � - _ _ _ _ --- <br /> _U -YlSi n�0 � <br /> ServiceAddress-� �������—`� UtilityAccountNo._ � I �1 � C _ <br /> r � ' <br /> i � i � { � Permit Fee � — <br /> Billing Address. -------- --- --- <br /> . ' [ <br /> C�ty, State, Zip�=' ' '�. � � � ' � �� I Connection Chargei>•1._ � ` ' � � ��" � � I <br /> Owner (Mortgagorl- '--��'_' . ' �= (�-1 l i Total Fef:._ _ � - -------- <br /> Billing Name���.. � I � . " �'� i � � <br /> Connectian B'V---�L_=—�-----�-=— <br /> Address� ( � � I - I' 1 L_� � . Siyned-- -------- ------- <br /> cus�o?�er <br /> Phone ' t . i, 1 _ ------ <br /> DESCRIPTIQN: Sewer District�� _��-� I-7i — - <br /> Lot_ Block -- Monthly Sewer Service_ '=' . ' ` ' ' -' <br /> Plat — -- <br /> Unplatted Description__ _ _— M,inthly Sewer Constr. <br /> -- - Trunk---�' � - --- ---- <br /> Type PermiC r i, , L.�� � _� �c ; � �. _i <br /> 1 L31C�a1 - � � — <br /> Remarks: _ q��i�iny �ut Line <br /> ;1V,.5 E. W- -- � � -----ft. <br /> — --- <br /> —. Appiovcd Y---. _.—_. . ___ .. ._ �_ —��-- <br /> c��v f�������.,.� <br /> _ — ------ Issur,dBy_/---"__ .. ' " � • ' • ,�l <br /> --- - ,�" \ <br /> - - � � <br /> � _ � � <br /> --- --------- Insper:tion �-!.v✓ /,�1'�`''/��, --- <br /> ----- --- 7'J � <br /> ------- -------- — -, , ., <br /> _ _ _ _.. <br /> _ _ Gcte Inspected__ ��� --r<-��— - <br /> — --- A <br /> SEE SKETCH AT'fACHED N� ZZ3�.9 <br /> iiasi'EC � itdi <br />