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I <br /> CHART NO.��� � �� - -5 <br /> everett <br /> � 5 ;�� i <br /> i � �-���7 � <br /> i � <br /> City of Everett Q/� <br /> / <br /> Sewer Application and Permit <br /> No. 22997 DATE <br /> Service Address Utility Account No. <br /> Billing Address ' , ' Permit Fee <br /> ` � � Connection Char e(s) <br /> City, State, Zip l � 9 <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> Customer <br /> Phone <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 /> � <br /> Remarks: <br /> Abuttina Lot Line <br /> N, S, E, W ft. <br /> i <br /> \, <br /> r� ! <br /> Approved By <br /> Ciry Engmcer , <br /> IssuedBy /. � �(./_., , �; . � <br /> Inspection By-� �� \ <br /> � Date I nspected_ S ����/� <br /> I SEE SKETCH ATTACHED N�• ZZ997 <br /> n�isr�tc� nor� <br />