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, , <br /> CHART NOd� y��` ' �' =% <br /> everetl � <br /> e � �o s �"�� : <br /> /2 -/ 3 -� Y <br /> City of Everett ' <br /> Engineering & Community Services � / C " <br /> Sewer Application and Permit � <br /> NO. i:� �.:� �_) �4 DATE « � - <br /> Service Address �y^' �^ �- � f ����� Utility Acwunt No. <br /> v <br /> 8illing Address�y�^� �'�'�—���li • Permit Fee_ `V ��� _ <br /> City, State, Zip` f/ . ��/�_. ' �c�U Connection Chargels) < ' �'� �-E'� <br /> Owner (Mortgagor) - >:-*:-I_../ �J� ' e Total Fee '�'�� �� _ <br /> Billing Name - �✓' <br /> � <br /> Connection 6y__ - � - '� __ j <br /> Address _. Signed -'c'�'� ' ` , r,+ .�y'�j <br /> c�n�ome, <br /> Phone �� ? ; ' G��i( <br /> DE:;f;RIPTION: Sewer District <br /> Lo�L' -�' --� Block -^��� <br /> Plat �.� � Monthly Sewer Service <br /> Unplatted Description _ Monthly Sewer Constr. <br /> Trunk <br /> Type Permit:,'., . ,.� ,3'_� . ' <br /> � � -- /�( . Lateral <br /> '_./< L• 1 <br /> Remarks: <br /> Abutling Lat Line <br /> N. S, E, W .� �- � - ft .— <br /> � <br /> ,. _ - <br /> -- Approved'By. �-_ <br /> Gry Enpmeer . <br /> r <br /> Issued By �"� - �—•% "'-- <br /> :/ <br /> Inspection B e ���� <br /> ___ _ _ _ Da[e Inspected ' �� <br /> u— <br /> ��, SEE SKETCH ATTACHED NC. <br /> iJ;I'LCiI� ' ��� <br />