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everett <br />� <br />City of Everett <br />CHART N0. � � ' �� "� - <br />Pasr�r� �-23-SI <br />Sewer Application and Permit <br />NO. G�95� DATE ' `�: � <br />, , <br />Service Address � � � ' Utility Account <br />:, <br />Billing Address' ' ! ���� ' - � � � <br />City, State, Zip �� : �' � � , ' ! / ' � �'� <br />Permit <br />✓ <br />Connection Charge(s) <br />Owner (Mortgagor) �� �%' • �� �--' `'' �` -- Total <br />Billing Name l ��. � i ,. � � "'` `" �''- — <br />Connection By '�i '� /� �' �-" <br />Address � � > �' ` ��- ` �� <br />, .,� . . � � , , � ._ , t <br />Phone ' '' ' <br />DESCRIPTION: <br />, <br />Lot � � Block %! <br />, <br />Plat � , '� .�. .:- T, <br />� . c <br />Unplatted Description <br />� � <br />Signed , • <br />Customer <br />�� <br />Sewer District / <br />/' ! <br />Monthly Sewer Service "- ' ` - <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, N% - <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Approved By " ' ' ' "' '' � <br />Ciry Engineef <br />Issued Bv (� � ,--; � <br />. <br />Inspection By <br />Datelnspected � VNF� <br />No. �395f� <br />