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� �� <br /> CHART N� —'� �Y%sr <br /> everett �0� �i/ /�' <br /> e ,�_ z: _ � � : <br /> c�cy or e�e�ccc ,�,�� <br /> Engineering & Community Services <br /> Sewer Application and Permit , ' <br /> N0. �r' i' �, �'� �) DATE �� �7 ll <br /> � / ' 1 �'�;� <br /> Service Address ' ` �r �{ ' -�h•'�J -i�' "" ' ��'lity Account No. <br /> , �� �7 U% <br /> Billing Address �G ^ y ' --i°`' '"'r -� Permit Fee �� <br /> City, State, 2ip;_.f.� �t�' ��' "` �% Connection Chargels) �� <br /> �O�� <br /> Owner (Mortgagor) � � � 4 ' � t / ' Total Fee -� <br /> . � <br /> i <br /> Billing Name � � <br /> Connection By <br /> � � <br /> Address Signed - — <br /> c����o�� <br /> Phone � { 'i — /�C G -- <br /> DESCRIPTION: Sewer District — <br /> Lot -�- � � Block � Monthly Sewer Service�50 <br /> Plat �(� �! �/. .�_.._.. /z7 - <br /> Unplatted Oescription _ _Monthly Sewer Mnstr. <br /> Trunk <br /> Type Permit: ~? ' � <br /> / ;.,:- <br /> Lateral __ <br /> Remarks: Abutting Lot Line <br /> N S, E, W ft. � <br /> 1 �. r <br /> APProved$M.1_ f...,.. ."`''`s <br /> ' Ci�y Enpineer / <br /> i� � <br /> Issued BY �i ' ����`. . <br /> � <br /> _�Inspection By�:C� <br /> Date Inspected / Z�� �o - <br /> Y <br /> SEESKETCH ATTACHED N�• ' I <br /> ��_� i i ; � � r � � <br />