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CHART N0. '�'- �9 z�rS <br /> everelt - y�s�'�'�� <br /> � � z-z: 6 -�f .-= <br /> City of Everett /� `r, <br /> Engineering & Communiry Services .. <br /> Sewer Application and Permit �„ � <br /> :� r, '; % '� DATE ll��/ % ' � <br /> NO. ._ c. ;; � <br /> �: � 1 <br /> Service Address - > > t ' � Utility Account No. <br /> Billing Address � Permit Pee '"' - � i <br /> City,State, Zip Connection Chargels) "`� r_~� � <br /> Total Fee - " �`�' <br /> Owner (Mortgagor) -- � <br /> i <br /> Billing Name ' " <br /> '� ' '" `v <br /> Connection By �--� � "� '' `� - <br /> �• <br /> --- _�- <br /> � Si ned _ <br /> AOdre55 r�'� g ` C�stomer� <br /> , �Phone <br /> DESCRIPTION: Sewer District_ — � <br /> Lot 91ock Monthly Sewer Service �' <br /> Plat I <br /> l!nplatted Description �—Monthly Sewer Constr. i <br /> I ��� <br /> Trunk � . <br /> Type Parmit: - -: .� ' <br /> I�teral_, � <br /> ' � Remarks: " O •� �' � '�� butting Lot Line � <br /> N S E W ft. i <br /> _ <br /> { <br /> . �i <br /> _ Approved 8y _ _- J r• j <br /> City EnBineer � <br /> . Issued By ' - / / � <br /> i <br /> �-�,. ' ' � <br /> lnspection By� . ' <br /> Date I nspected �/��?� ' <br /> � <br /> o ,.. <br /> SEE SKETCH AttACHED N�� ` I�� `� '� `, I <br /> RJSP�CTIG��� <br /> i��� � <br /> � � r ..�._ 's�• �' <br /> I <br /> ' — - — --- - <br />