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everett cHART No. t #! �"i - S � <br /> � f:J ` i .�� �j I <br /> City of Everett ///� �7 � { 1 <br /> Engineering & Community Services ! <br /> / s'.a'j /r � � <br /> Sewer Applicotion and Permit � <br /> i i <br /> NO. �! � .� 1. DATE � �c1'� • � <br /> ServiceAddre;s—.,�U/ L � ,/ J; . ,` I i <br /> "l�lSliiy Account No. __ � <br /> Billing Address �� '� � • ��'' <br /> Permit Fee /i1 <br /> City, State, Zip ' �_% !w / . j�.� Connection Charge�s) "'"`—_ <br /> Owner (Mortgagor) � _ ,, ;v � <br /> Total Fee <br /> Billing Name__ ' <br /> Connection By_ ' � � / r� / r <br /> Address _ � Signed '`+. ( ,/������"' <br /> . .... . . Phone l�:���/ • " ' /�/�_ u:�on,er <br /> DESCRIPTION: ' ! , Sewer District _ i� / __ <br /> Lot� - !^ 91occ�1 <br />, P�ac�_ J' � ,�/ ,_, Monthly Sewer Service ~� f <br /> Unplatted Description_ Monthly Sewer ConsV. ! <br /> " Type Permit: j , = , ' Trunk + <br /> �`"' ` Lateral � <br /> Remarks: - <br /> ` - Abutting Lot Line <br /> , N, S, i-, W. -- — �ft. <br /> _ A��proved By � <br /> Cily Enpineer <br /> Issued By �_ % I <br /> T� <br /> - --- � � � / � <br /> _ Inspection By � i''�—*-n-t' � <br /> � i <br /> p ------ ------------- Datelnspected_�_- //_ 7,r' � <br /> SEESKETCH ATTACHED I <br /> ��� � N O. � <br /> � I <br />