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� CHART NO.���= � <br /> � � �� - �,n - �� <br /> EwCreM <br /> � <br /> City oi Eyerett <br /> S�zwer Application and Permit <br /> No. 23069 DATE f— <br /> — �__---- -- — <br /> Service Address � __ Utility Account No. <br /> --.--T------- <br /> Biflinc� Address.� � Permit Fee_-- <br /> / Connection Chargels) — — <br /> City,State, Zip <br /> / Total Fee__—_ - <br /> Owner (Mortgagor) - <br /> -- - ----- - <br /> Billing Name <br /> Conneciion By_ <br /> Signed _. ------- <br /> Address c°"°""` <br /> Phone — <br /> / _ _ <br /> DESCRIPTION: � Sewer District _-_- ---�— <br /> Lot_—.---- Block Monthly Sewer Service_ <br /> Plat_ — <br /> Unplatted Description —_— Monthly Sewer Constr. <br /> Trunk <br /> Type PermiC Lateral <br /> Remarks: Abuttiny Lot Line <br /> --- N S [. W ft. <br /> ---— <br /> � , ;' <br /> AppfOV¢d By GW Engmeer <br /> ISSU¢d BY----___'-_ ! — <br /> __ - . � � '? c, <br /> Inspection By '`��`�Q� � —�_�� <br /> - ---- --------------- <br /> Date Inspected_!?✓�I�----- <br /> __-. _ No. 23069 <br /> SEE SKETCH ATTACHED <br /> INSPEC110N <br />