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CHART N0. <br /> eve�ett - <br /> � �ST�'1> <br />� City of Everett <br /> fd/��?f <br />� <br /> Sewer Appliccation and Permit g� <br /> i NU. 22845 DATE �/7��: <br /> I <br /> Service Address i' Utility Account No. <br /> Billing Address Permit Fee � <br />( City, State, 2ip � � Connection Chargels) <br /> Ownr,r (Mortgay r� Total Fee � <br /> Billing Name_ <br /> Connection By , <br /> �I <br /> Address Signed " <br /> Cuslomer <br /> Phone_ j � ,.__. <br /> DESCRIPTION: Sewer District I <br /> Lot Block ,�,! �"J- <br /> Plat Monthly Sewer Service _ <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line _-- <br /> N, S, E, W ft. <br /> Approved 8y <br /> Ciry Engineer <br /> Issued Ry --_�_-__. <br /> Inspection By�.�'1,�y _ I <br /> (/ b�— <br /> JDatelnspected ��-�/p'- 7 9 <br /> i <br /> SEE SKETCH ATTACHED Np, 22gq5 I <br /> ir;s�ec�nor, <br />� , <br />