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, evMCn CHART.NO._� <br /> 1 <br /> �� ,• - <br /> City of Evcrett -•- <br /> Engineering & Communiry Services <br /> Sewer �4pplicafian and Permit = <br /> MO. ��O Z 3 DATE _� �"'� ' 77 i <br /> Serv�ce Address_ �J lYf.y C��u... ._ „i.r�Utiliry Account No._ <br /> � ' G <br /> Billing Address��Q• •tr�� . ��� Permit Fee r-� �' <br /> i � — <br /> City, State, Zi _� - -�• � {� -� <br /> � , �,, 1'� ��� ��� Connection Charge(s) � <br /> i • i• y u � <br /> Owner (Mortgagorl:rc.'.,c^'-� � ��:- . l •�� Tot�l Fee__ � �' � <br /> Billing Name_ /1 i�,,....-�—� <br /> Connection By_ /..G�—.L�� <br /> Address_ Signed /`� <br /> Phone 3S3- //3S c�.�o„k� <br /> DESCRIPTION: • Sewer District 3E' ' '�. f T!L- <br /> Lot Block <br /> Plat Monthly Sewer Service ' �� <br /> Unplatted Descriptiorr- ' +T..: ._,.�. • !T%%y :,� S({i� <br /> . anthly Sewer Constr. . <br /> ';'_ /.Z %;- a �R � �'.•-�� � . <br /> Ty�e Permit: s � " � Trunk <br /> G�,:.vo=�'• .. � • - <br /> ��: ./� Lateral_ <br /> Remarks: <br /> — Abutting Lot Line � <br /> — N, S, E, W h, , <br /> Approved By f �� � <br /> Gry Enpineer . <br /> , �J �� �. <br /> Issued By-. � .:�.�_ <br /> Inspection By <br /> o Date Inspected _ <br /> SEE SKETCH ATTACHED NO. Z��) C � <br /> r _. _ _ . . . _ � INSPL'CTION �- _ - -- -- . . <br /> _ . _.. ,._. <br /> 1 <br />