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. .� <br /> CHART NO.�-��_�-�' —� <br /> everetl , <br /> 7 --� .� <br /> e %�^-� �� =� �, <br /> � � � � <br /> City of Everett ✓� Q /<� � ,' <br /> /� <br /> Engineering & Community Services <br /> Sewer Application and Permit � <br /> NO. ;� � T Q u DATE _ ( L � 1 � �-;'7 <br /> (� Service Address `-� ( ' � � - �' '�- �-�=- ��c.. c_ Utility Account No. - �' <br /> Billing Address �#" ' � 1 �" �' ��'' � < <--� Permit Fee <br /> y � ;c_:>_ r�1 = ) % "Z ; � r ' <br /> Cit , State, Zip - . ConnectionCharge(s)_� !=C- ' ' t -fi , ;-, <br /> i <br /> Owner (Mortgagor) = � � ' �- "' ! -' Total Fee_ ` '� <br /> Billing Name �=" " �-- <br /> �� r. <br /> Connection By =�+�^ � � <br /> j ��, <br /> `� - . .. ��'.`,,/ -- ; <br /> � Address `�' � r ;l 1 t. �. � c_... Signed �s�-- .:� ,; �: ! [�":, ., ,� <br /> � — � �Custom r ' <br /> Phone � �� `� �`'� �'� <br /> f DESCRIPTIO�!: Sewer District � ` � - � .�� : � <br /> � Lot �<< _ Block <br /> Plat— � � c.t r «�i : ;- c . � Monthly Sewer Service - � '--� <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: }-� " Trunk C . �Z �-� <br /> E. , v L�l:l_JL�C.t.:�r l .. <br /> Lateral ""— <br /> Remarks: <br /> Abutting Lot Line <br /> ( N, S, E, W ft. <br /> I! <br /> iI <br /> ApProved By—,- .•'. 1��1�1 � �� <br /> � Ciry Engineer <br /> Issued By - � <br /> � <br /> i <br /> I <br /> � � <br /> i Inspection By <br /> � <br /> / 7 <br /> Datelnspected � / � <br /> � 8 . <br /> � SEE SKETCH ATTACHED � Np. ;_ � <br /> I li�!SPECTION <br /> ! ._ 'A .�._ i __. :ti�'_`+1. .�d .�:;�, <br /> �-'-.� <br />