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jUvG i/-z t �5 <br />everetl <br />� <br />City of Everett <br />Se�wer Applicc�to�n and Permit <br />No. 23261 <br />DATE i �`'' ��q�- _ <br />CHART N0. <br />(J � �z -Z8' / <br />�:;-., <br />, �% Utility Account No. <br />Service Address - " <br />/ Permit Fee ; � <br />Rilling Address � � <br />� i . <br />_ ' Connection Charge(s� <br />City, State, Zip . ' <br />Total Fee <br />pwner �Mortgagor) ' <br />Billing �ame�� —�— <br />Conrection By !/�"�V�-�`�`' V� <br />._ $19�� Customer <br />Phone <br />DESCRIPTIOf�I: <br />Lot _-- <br />Plat _ <br />Unplatted Desci <br />Block <br />� — <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />� Trunk <br />Lateral ' — <br />�butting Lo' Line <br />N, S, E, W �— <br />SEE SKETCH ATTACHED <br />II�ISPECTIL�I� <br />approved B <br />Issued <br />acv <br />( j i <br />\I.r ' v <br />Inspection By— <br />(� 'f��,. •��i <br />Date Inspected �1� � <br />No. 23�61 <br />