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CHART N0. _ <br /> everett <br /> � � <br /> �� <br /> �,..a,�c� <br /> City of Everett � a� <br /> K � <br /> Sewer Application and Permit ( � - ' ' � � �� <br /> � I <br /> N0. 24ZZH DATE /� � �� ?� I <br /> Service Address���?�� �t" � �%�V�Y Utility Account No. <br /> � / � /� �v <br /> Billing Address_= � S�'S /v� 7�L Permit Fee I <br /> City, State, Zip��;tyu��<<:z/y_, 1 �,,.. �f � -'c, Connection Chargels) i <br /> / � <br /> Owner (Mortgagor) -�� � -���' - — Total Fee (�� � <br /> i <br /> kSilling Name��l� ''""�-� � <br /> Connection By ,I <br /> Address Signed <br /> Cusromer <br /> Phone i <br /> DESCRIPT ON: Sewer Distric. � <br /> I Lot �lock <br /> �� �✓ � Monthly Sewer Service_ <br /> I Plat ,'-cc�. / ,�._�" � <br /> Unplatted Description Monthly Sewer Constr. � <br /> Tru n k , <br /> Type Permit: � � � <br /> Lateral <br /> � <br /> Remarks: <br /> - Abutting Lot Line <br /> ' N, S, E, W ft. <br /> � _ <br /> Approved By — <br /> Ciry Engineer ' <br /> �SSII@d f�Y ' �.. <br /> // % /_ <br /> Inspection �j , <br /> � <br /> 0 <br /> ' _ Datelnspected_ <br /> SEE SKETCH ATTACHED N0. ��F c3 ! <br /> i <br /> I <br /> li�:jl'fiCl!Gid j <br /> � <br />