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! r��/� <br /> � CHART N0: ' 'd�� ?'�-- � <br /> everett ,� �J � ' <br /> �p`1 1� � , ; <br /> �I /����JP' ' <br /> City of Everett <br /> � <br /> . I <br /> Engineering & Community Services <br /> { <br /> Sewer Ap�lication and Permit � ' <br /> � <br /> ; <br /> �� � I <br /> � �� �� n s -/v'- IF.' � <br /> N0. __ � � �-, _l_ DATE <br /> '� ' � � � S� v�- i �r'i'� <br /> Service Address Y��� � � -��`%-"'� J�`—`''`"'Utility Account No. � <br /> o;..-r <br /> BillingAddress�'U/ �f`7• `�/. ��� PermitFee �� — ' <br /> City, State, Zip '�` '_, �� �L. rr�77 Connection Chargels) �/JU �� i <br /> U�' <br /> Owner (Mortgagor)f/�"�r;: � - c�,��>• a� Total Fee � O �_ � <br /> � y �Billing Name "�.='-:.��- `"' <br /> Connection By "�' -�--' � <br /> Address 5igned ", ' <br /> 3�� - ,:�o / � ',.. <br /> Customer <br /> Phone _,,.s''�� <br /> DESCRIP ION: Sewer District /� =�^', � / <br /> Lot_ . � Block �^-�!��''✓ � , 5 G1 <br /> � �. J Monthly Sewer Service <br /> Plat � � <br /> Unplatteo Description. = �` ' � � - Monthly Sewer Constr. ! <br /> . :'�! � t ��G.'- �S /� <br /> ' �` , r-. Trunk J[�. .:�� <br /> Type Permit: ;:�: _ � [,..-.= /..r.,,._..f <br /> .�-��--+�^' . <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W_ ft, � <br /> , � <br /> 1 <br /> � <br /> � i <br /> , � , i <br /> ApprovedByr� .f���.,-..•:,c�--1 ' <br /> ' Ciry Enpineor � <br /> �t' /`�� � I <br /> / I <br /> Issued By �' ' �f--�-t�, � <br /> i <br /> � <br /> � <br /> , <br /> Inspection By��`�"' , r �`� I <br /> (/ �% , <br /> Date Inspected ��� � �� � <br /> a - , <br /> SEE SKETCH ATTACHED N�• � ` -� � <br /> INSPECTION f <br /> z:_ t � r f; .� . . tu; . � � <br /> . „ , . <br /> � . .,. •. _ :,,, `_ <br />