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� <br /> i <br /> � CHART NO.0 � 1 - -, i � <br /> everett <br /> I �... ' <br /> , e � , ` <br /> ,��� ,- � � { � <br /> � City of Everett �p` <br /> Engineering & Community Services <br /> �.:i <br /> � Sewer Application and Permit ' <br /> I <br /> N0. � 1 `..l G i� DATE )!- � - % J <br /> I �/ff <br /> ! Service Address_ 'S 3 � � �J�/-•��'L�Uaz�� Utility Account No. <br /> Billing Address 1 %� � � � '��.-�- Permit Fee � <br /> City, State, Zip �:�' � � • ���✓ �'�'.: O✓ Connection Charge(s) <br /> '� � -�--- Total Fee �� <br /> Owner (Mortgagor) ' <br /> Billing Name ' �-� <br /> ( ' ` � <br /> Connection By � - ` "� <br /> Address Signed <br /> Cux�omer <br /> Phone <br /> � DESCRIPTION: Sewer District % `� r � /11— � <br /> I Lot � Block � � <br /> � Plat � -;' / � �; � - ('j Monthly Sewer Service ' <br /> i <br /> iUnplatted Description Monthly Sewer Constr. i <br /> 4 Type Permit: - � Trunk (='• =: > <br /> { - /._..., (.....r_ /� <br /> � Lateral j% <br /> ' Remarks <br /> Abutting �ot Lin <br /> �� �• �"' - . �- <br /> I � �- c� N, S, E, . I r., ft. <br /> I � �' <br /> �n2- J C. /�/ <br /> � /�.t�� <br /> i . <br /> I <br /> � Approve�l By <br /> Ciry Engineer <br /> iIssued By __ <br /> I <br /> � Inspection By � �-•�-�-�^-�� <br /> � <br /> p <br /> Date Inspected Y —IG - 7 7 � <br /> i SE[ SKETCH ATTACHED N0. <br /> � IfVSPLC1lON <br /> :�r _ <br /> `Cri <br />