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.;:�,. <br /> everett , CHART S=g-`S-' <br /> e . � � � <br /> ��s i� ;� <br /> , <br /> � i <br /> City of Everett ^� `� �� <br /> Engineering & Community Services v <br /> Sewer Application and Permit � <br /> � <br /> � <br /> , <br /> N0. ``' _' .. .; :� � <br /> DATE 10 - / /_ y� <br /> Service Address f` � �r ' - <br /> � , �`Utility Account No. ' ':^ i' .%' :' <br /> Billing Address � �':G -. �_ <br /> Permit Fee - � i <br /> City, State, Zip_ � <br /> , - <br /> � Connection Charge(sl_L`r�' -� '' �------- j <br /> Owner (Mortgagor) _ � i <br /> � Total Fee , .;' �'' <br /> Billing Name j � ! <br /> Connection By ✓ _ ! <br /> , <�; <br /> Address �^� , , �.`, G<`` , , <br /> Signed ` - ���-s� C.�i. � ' ! <br /> Gt'��-a- ,�' <br /> Phone %, j ._ �� :� U Cusromer -��" � . <br /> i <br /> DESCRIFTION: ! <br /> Lot� � -'i Block/D Sewer District= .-� r ��� <br /> Plat � Monthly Sewer Service ~� <br /> Unplatted Desc�iption ' <br /> �_ <br /> Monthly Sewer Constr. ' <br /> TYPe P�_ �"�- — '� . Trunk - , f ' ' I <br /> � -�_ � <br /> Remarks <br /> Laterel ;� -. I <br /> — i <br /> _ Abutting Lot Lin�e� ; <br /> � N, S, E;'r(N %'�� ft. <br /> I <br /> Approved By. _ <br /> Ciry Engineer i � <br /> Issued BY�__ .--� <br /> Inspection 8 �' <br /> a Date Inspected !-d - <br /> SEE SKETCH ATTACHED —�— <br /> �: v, �'''�. � {� - .� INSf'ECTIOf�I Np n ., n <br /> k�`��: `� i � } .��r'.��_ i , ,� ��. <br /> ��•>_ � �.,.� � �/���M ' <br /> 1 <br /> I <br />