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CHART NO�II'�3 � 'ZG_5 2 <br /> Qvere[t <br /> NoT a�J clln�q y�i�1A� <br /> eP�� .,�;�.� � -,y-� i <br /> City of Everett /� <br /> /�s f <br /> Sewer Applicction and Permit " <br /> No. 23372 DATE (/�� ��� <br /> Service Address y� � y � � Q1`� ^ � Utility Account No. <br /> _� o% <br /> Billing Address� r� ���� ��LL���� ' Permit Fee �D <br /> City,State, 2ip�,�Z— �� �(--�� Connection Chargels) o � <br /> ` 3 � i <br /> Owner (Mortgagor) ��s=-=�/� Total Fee <br /> Billing Name � <br /> Connection By ,�-= ':�:����'� ` I <br /> Address Signed�� - ' <br /> .._y� J Customcr <br /> Phone _�s� /u �D <br /> DESCRIPTION: / Sewer District <br /> Lo��BA�/'�+--�y�— Monthly Sewer Service <br /> i �' .,��i I <br /> Plat y - � <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk ' <br /> Type Permit: � <br /> Lateral i <br /> Remarks: Abutting Lot Line �� �� Q I <br /> N S E W���S� ft. i <br /> - I <br /> Appraved By���/�. �gineer I <br /> Issued By�`.�� O <br /> , <br /> Inspection By <br /> Date Inspected � ��� a2� *� �9O c <br /> SEE SKETCH ATTACHED No. 23372 <br /> INSPECTION I <br />