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i <br /> II <br /> I ' <br /> . � <br /> CHART NO. <br /> everett <br /> 7r� ��o��,,� <br /> �v/i(��q� <br /> City of Everett <br /> Sewer Application and Permit <br /> NO. Z H Z 91 DATE �---� �«iQ91 <br /> Service Address .�.y_�--Fols� Utility Account No. — <br /> Billfng Address --Z <br /> City, State, Zip ___r�n�—, Permit Fee $ ip, �� <br /> Owner �.�. Connection Charge <br /> Connection by _�m�¢ Trunk $ <br /> Address Lateral $ <br /> Total Connection Charge $ '� <br /> Phone Utility Development Fee �I <br /> Legal Description: Water $ I <br /> Lot Sewer $ I <br />� I <br /> Block Total Development Fee $ <br /> Plat ' <br /> Unplatted Description: Sewer Bond District ��'��!9� �'':S�`* �uit�a6':�-' G':k� ' <br /> , <br /> Abutting Lot Line qp�k;;tvl <br /> N S E W SENL'R f:l��.GC1 ft. <br /> Type of Permit Approved By <br /> Remarks L � <br /> �✓� Issued By T ��li <br /> 0 ^ - — <br /> `�ustomer Signature,—. ' <br /> o / ��IMPORTANT! � <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected <br /> SEE SKETCH A'iTACHED No. 28191 <br /> INSPECTION <br /> I <br /> � <br /> I <br /> I <br />