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/T- /3 ���'g"-� <br /> I � � CHART N0. — "• �' I <br /> Ieverert it'• '��o s, �'Lr'� i <br /> ( _ �`. . 1 �'e— � �� 7 � <br /> I � 5 <br /> �i City of Evere2t �/�1. <br /> � Engineerin� & Community Services � � / � <br /> � Sewer Applicat�on and Permit i _ <br /> � " _ ," � <br /> � ,� �, :, .� _ DATE _: �'_...� / r <br /> N0. `� � � v _ � <br /> k� <br /> f Service Address � �` � �� �!` �"�� L�'"� � ?l��7 Utility Account No. <br /> ! � ,tik_ C�� � ,' IJ,,vIUC: �� � c_ r._-L <br /> iBilling Address ` ` - �' � �' � Permit Fee <br /> Ciry, State, Zip��-�=�=�� � �-� ��'''l ��f:� G '-. ConnectionCharge(s) <br /> ! <<- ,, <�'•- <__c.,,: �� Total Fee r'��. i4'� <br /> � Owner (Mortgagor)_ <br /> � <br /> ` Billing Name J�''"'`�- � <br /> � Connection By �`' ' `' � �-- ` ,_' �""� >' <br /> � Signed �..1�� ��,I L_� � �: ��. � !'� c r : <br /> i Address Customer <br /> I <br /> '� Phone <br /> I � <br /> �' DESCRIPTION: Sewer District_ <br /> � Lot Block Monthly Sewer Service <br /> � <br /> ! Plat <br /> Unplatted Description � � �- "� �-�t__' Ia N� ��- Monthly Sewer Constr. <br /> l - _ -Z_f= - ":� <br /> Trunk <br /> � ' . _ <br /> � TYPe Permit: �`..�t=:_�. �._.� � t._�. ,a� <br /> Lateral <br /> � <br /> Remarkr. � <br /> v <br /> •r.e. c��" lr • S Abutting Lot Line <br /> i _ � . � N S E W ft. <br /> ' , 'L irs«t <br /> ; � � , <br /> ' /.��_ �cc%a d� �� l�- � J • il <br /> � � <br /> 14 ApProved By l'" � � `��rvl i_i�� <br /> � Ciry Engineer '� <br /> j Issued By L. �- i \�-- �- ' `i � ,� �J � <br /> . i I <br /> i � I <br /> Inspection By � ° •' � `y�'-`"°'�'�""��+ ' <br /> �� Datelnspected 3 - � 7 - 7 Y <br /> ; � -. , ; <br /> SEE SKETCH ATTACHED N�' - ` ( �`' �" � <br /> INSPECTION <br /> _ =� <br />