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CHART NO. T J � z 7�S <br /> everett , <br /> � ��57�/� <br /> City of Everett /��Z�� 7 S <br /> Sewer Ap��ication and Permit 93 <br /> No. 23230 DATE /�� <br /> Service Address 7� "� Utility Account No. <br /> /, _.=- <br /> Billing Address � / Permit Fee ' <br /> �-- i <br /> City, State, Zip � Connection Chargelsl— <br /> Owner (Mortgagor) ` =' Total Fee I <br /> ! <br /> Billing Name " <br /> ; <br /> Connectian By � ' <br /> , ;; <br /> ,:.a ;i,! ; . <br /> Address Signed`- '�' "" <br /> Customcr <br /> Pnone : - <br /> DESCRIPTION: Sewer District <br /> Lot: '� ' Block <br /> ! Monthly Sewer Service <br /> Plat_� <br /> Unplatted Description Monthly Sewer Constr. <br /> _ Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: ' ' 'r`nC...• <br /> Abutting Lot Line - ; <br /> N, S� E, W / it. <br /> Approved By <br /> Ciry Engir.tler <br /> Issued By <br /> )� i <br /> <<� , , <br /> Inspection By ,r _ <br /> i ,ti.� • <br /> i Date Inspected �� � " � �� � <br /> � SEE SKETCH ATTACHED No. 2323Q <br /> IN:," :110N <br />