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CHART N0. ,. i�.-, _. r :/_ ;' � <br /> everett �, ' <br /> i <br /> '�, ;:: <br /> / , <br /> ,Pa�� @ ' , <br /> City of Everett �, �G.�'�/ r� / ' ' <br /> ��.. . . <br /> Engineering & Community Services ��� <br /> Sewer Application and Permit <br /> ��. . <br /> N0. �' � J i � DATE — /�/�%/s',' <br /> — I <br /> Servic: Address ��- ��"` �-_�`" �� � -�� • Utility Account No. 1 <br /> � ! � +�`�-^� i <br /> Billing Address ' �� -' �� � � �� Permit Fee -� U � <br /> � <br /> � <br /> City, State, Zip � � �` Connection Charge(s) <br /> -� . J =- <br /> Owner (Mortgagor) Total Fee ..�J � <br /> � i <br /> Billing Name - _ i <br /> Connection By - c � <br /> � � <br /> Address Signed- ��.!/t� c�Ei��� <br /> Customer <br /> Phone '' i '�� i( r � � <br /> I <br /> DESCRIPTION: Sewer District � <br /> �— '` i <br /> PI t � B�ock /l . ' Monthly Sewer Service ^�' � J I <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: i .. � Trunk �' <br /> ' Lateral � <br /> i <br /> Remarks: � <br /> Abutting Lot Line � <br /> N, S, E, W ft I <br /> , I <br /> I <br /> — I <br /> • � <br /> .. � <br /> Approved By-- .c°`-� - ; <br /> City Engineer � <br /> i <br /> IssuedBy � ' ' �-/� i <br /> � <br /> i <br /> t <br /> Inspection By _ <br /> Datelnspected / Z A�7./� <br /> a <br /> SEE SKETCH ATTACHED NO. ' ._ '' f� i <br /> INSPECTIOtJ ; <br /> � <br /> , _,...� �. __ - —_.z _ � .- - - <br />