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1 <br /> r����- �� 1�" ��s CHART N0. T � �Z� y <br /> Ie�•erett <br /> I � �c..� <br /> City of Everett %�� �E� <br /> ,s z 9 s <br /> Sew��r Applicatior� and Permit �3 <br /> I <br /> INO. Z3O79 DA'fE ' l <br /> � <br /> i Service Address�l� � �1�����z --���-r Utility Account No. 7.��'� C <br /> 3 `cr� <br /> � Billing Address �� - �J��� Permit Fee <br /> I �� ,/ �-- <br /> � City, State, Zip /- ��/.� - �O Connection Chargels) 7 �U <br /> ,�� <br /> I Owner (Mortgagor) � -� / � Total Fee j� n <br /> � Billing Name <br /> i <br /> Connection By -<-3.� � � <br /> , <br /> I Address Signed c�:��m�� - I <br /> Pho�ie 3.1.�- // 3 �,_.i <br /> ' " 3 �,� � <br /> i� DESCRIPTION: �tfi� 7s/� Sewer District I <br /> � Lot ' B1 ck <br /> � �/ — Monthly Sewer Service � ' S-d I <br /> � Plat—�'��"a <br /> � Unplatted Description Monthly Sewer Constr. i <br /> I � <br /> � /v Tr,,.:k__ D. �O /oo <br /> Type Permit: '��,�s1- C�z-.--.�; ` ' , v1�- <br /> � Lateral � -�0 ,�d � <br /> � Remarks: I <br /> Abuttin, Lot Line � <br /> N, S, E, W ft. I <br /> I <br /> � ' i <br /> I <br /> � ), ' I <br /> � <br /> Approved By c-� � <br /> 'Cily Engincer ^ <br /> Issued By (n�• �r-��_ � �� <br /> I �. <br /> ;�•ti n <br /> IInspection By `�'��� `� � <br /> _ _ Date Inspected �� � � ^ / 7 � _ I <br /> I ' <br /> I SEE SKETCH ATTACHED N�. 23079 ! <br /> � <br /> i <br /> � RdSPE�:1 10t: <br /> i _ <br /> ♦- <br /> �. <br />