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i � <br /> E � _ .. <br />,I . , <br /> I <br />� <br />, <br />� <br /> CHART NO. <br /> everett � <br /> ��� e :; TO POST1�� �,_zs_�, <br /> ��� City of Eyerett � � � ; w� � � � � � � <br /> S_ � � r.,�, �.r�, o � , <br /> Sewer Application and Perr�ito � LL = � � � � `-}�� `�Y "� <br /> � fJ <br />,• ����y Q pv � 'r ` ' �.1� F, ti �. F W � <br /> y r ! ' i _ � : � � � �3 � • � h � <br /> y� 71a . ' `s .".`. r _ :J � sc�'�i .�'.. .'�•� a � l� <br /> a � °t�° NO. ZSZ.�H DATE ��n,l�_�/_� <br /> OW Servia Address _ ��7 r•l P N �•,�n�n�/ Q- Utiliry Account No. <br /> �H Billing A d dress �"��) – r�..3] 7� J'� �� <br /> �H City,State,Zip �� �T.� ! � �t,/,� �� �fo Permit Fee $ ��r� ��L� <br /> �" (�e�t I <br /> � Owner �* �o � �(z��1C Connection Charge <br /> �� Connection by Trunk $_ �`�-� 6r:� <br /> Addresa Lateral $ "� '��'��� � <br /> � Total Connection Charge $ �.l � r i( 1 <br /> Phone 5 --75e�3 Utiliry Development Fee <br /> 1, �� LegalDescription: Water $ � � .;.,j � <br /> Lot Sewer $ —�� `��� ��(� <br /> Block Total Development Fen $ � � 1 <br /> i Plat <br />� ; �1_' UnplatledDescriptfon: _ ./ ` / .•. �� SewerBond " 'strict _—�_ <br /> IAbutting Lot Line <br /> _ _ N,S, E,W ft. <br /> �� l'ype c' 'ermit .� � ( � :� �• , � �. . � _ Approved By <br /> Rema .<; Issued By � • 1 <br /> , __ t <br /> �.�. Custoner Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS � <br /> PRIOR TO l�IGGING ' <br /> ��� � <br /> I. �ection By�— <br /> CALL 25�J-8810 FOR INSPECTION /o /� �� <br /> Date Inspected — <br /> SEE SKETCH ATTACHED NO. ZH�3 ti <br /> INSPECTIO� <br />