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it. n b:1�; � . <br /> a`,, e.;�t}i . <br /> � <br /> 1 '4�� i <br /> � '' <br /> ]� . <br /> \. . <br /> CHART N0. ^ ` �� � '�'�' <br /> everett � ap� -��� :. . .;' ' <br /> � �,.r � <br /> w r �. <br /> � � rt ��, t �ht' . .• � . '"'_ <br /> � . ` � .� Z � K',,.'- i'^� <br /> '—p �f� L � iL�♦ <br /> ]:} ; ^ <br /> C•:` ... SA4 <br /> City of Everett c•> ,� <br /> Engineering & Community Sarvices <br /> » <br /> Sewer Applica��ion and Permit ` <br /> �. <br /> No. 22.258 DATE � � 7 /1r <br /> Service Address �F�f? ; �- J �%/�_- i Utility Acc�unt No. 3 - j S- .�GD - Q / <br /> ,/ w,:'�� , .- -,d ;s <br /> Billing Address �-� %�- �� ' '!� �-�' ��/���, / .�' - Permit Fee -� <br /> <' _�— �>- / �-�'' <br /> / .:�� s' �'�:' S` /t� =: ' /+�-r/ <br /> City, State, Zip%'��' _• ��`�� '✓"� �• Connection Charc�e(s) <br /> r �v a� <br /> Owner (Mortgagor) �-' -''--y �--��-•-�;�- _ Total Fee � <br /> Billing Name --' ! " �--� � . <br /> �,Y 1� U � <br /> Connection By -- �f f , 0- _.� <br /> f � ' <br /> Address Signed��i�-F--`��-�=r`s�—� <br /> CGstomer <br /> Phone �G % " D '�Q v .��- <br /> DESCRIPTION: Sewer District -'s S �=-=�' � r �� <br /> Lot Block ''— <br /> Monthly Sewer Service =�-'•% �• y �' <br /> Plat <br /> Unplatted Description --%r:. . �J.`�%✓ �%: ��f Monthly Sewer Constr. <br /> � <br /> � J � <br /> � � -i X • J ^ `�t�;.7� Trunk � "'' - <br /> Type Permit: ;!7. � � . _ �r-,.� e�/;,- �'1 �I � _ �— <br /> L3terel `+ �� <br /> Remarks: <br /> Abutting Lot Li �/� ft. <br /> N, S, E� <br /> � <br /> � �� <br /> ... _ ,, :` -;->: . : i <br /> r — Approved By <br /> ICity Enpineer ' <br /> � �, � <br /> ;- , <br /> Issued By n ' <br /> Inspection By <br /> Date Inspected <br /> A <br /> � SEE SKETCH ATTACHED N0. �2 Z 'rJ 8 <br /> f INSPECTION <br />