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� <br /> CHART NO.�-' Z`r �Z�T- S <br /> everett � �'J' c.? �r ' � ^ " <br /> �� �+ � �� � �/ <br /> � O ./ ' <br /> /�� . � . <br /> �}t�r of Evereti � <br /> Engineering & Community Services � <br /> Sewer App���ation and Permit . <br /> _ ; � <br /> -, n � r `� DATE 'i - ,:' - i i ., <br /> NO. l C � � � � <br /> . , - `�' • -;,/ Utility Account No. <br /> Service Address � � ,,.� --- <br /> Permit Fee �i <br /> Billing Address <br /> Connection Charge(s)�--- <br /> City. State, ZiP -r:;- , - <br /> Total Fee � <br /> pwner (Mortgayor) <br /> Billing Name � �. <br /> ( i ' f � ! <br /> . , . . . � . �. - <br /> Connection By � r, C � - <br /> J Signed Cusmmer� <br /> ; Address <br />�;:: <br /> Phone I <br /> $ewer District____. . � <br /> DESCRIPTION: MonthlySewerSerrce � " <br /> Lot�-- Block�— <br /> Plat � Monthly Sewer Constr. I <br /> Unplatted Description Trunk , <br /> Type Permit: � Lateral � <br /> Remark�: ;. - � � Abutting Lot Line ft. <br /> , N g, E, W. <br /> _---- _ � �• 7�y 1 <br /> i -s� C i�[ . �✓ r' • i <br /> - � . . M� , f-� .�-w � � :, ,- ' i <br /> _ CC 1 ` � _ I <br /> qpproved BY - ' ' <br /> City Engineer � <br /> — ' /� <br /> Issued BY� �— r <br /> ry � / � �����e ��� . <br /> Inspection BY `s <br /> Date Inspected z" � �� <br /> � N0. _ . ; ,"i <br /> 0 <br /> SEE SKcTCH ATTACHED INS�r�i��i� ' <br /> ��},`�'.��n��� . , - _ z __ _ . .__� <br /> 'Jw_� ar t�� ' � ' F � ._. . . °!7. 'd. <br /> , 1 <br />