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Ai. <br />everetl <br />e <br />City of Everett <br />Engineering & Community Services <br />t� <br />'�n ra•'��" ��w <br />~. <br />�,> <br />� .� <br />M 1•M1 <br />Sewer Application and Permit <br />NO. � +I g �� ;' DATE � � `—i'i <br />Service Address�� `—����- �---' <br />Billing Address �����' � ��J�'��'r�T" � <br />City, State, Zip CNC//e'���i a/•/ �`��'Z`'� U <br />Owner (Mortgagor) v�'�-`�'"� G hilc. (_L.,� <br />BillingName G�=�.����-' G. r�t��v <br />ConnectionBy CL'�,w C- l"tL�,ci <br />Address (�� V G=' �`��'��E-� ST <br />Phone `-•L<'� — �G' -�f !P <br />DESCRIPTION: <br />Lot (r/ � �1��1- �Block��t'-� �-oT 1'=, <br />Plat_.�;_�-��-k-L: C.'/,�z�>t..�) ��G. <br />Unplatted Description <br />CHART N0. r '� �"��"�- <br />/�o s % �'�� / b <br />�. <br />j ^ � � <br />Utility Account No. � � —V �-` �' <br />Permit Fee � �7 r�U <br />Connection Charge�s)_ (" )��•' � �U `� <br />Total Fee <br />4 U c: c, <br />%i �� � <br />g � �jjr , <br />Si ned L-r��ti"a`-i ��- • / vl�_ <br />Customer r �. <br />-� � V, i�`.�C� �..� i� � <br />Sewer District <br />MonthlySewerService h��'�-��-�'t—'� <br />Monthly Sewer Constr. <br />Trunk_ <br />Lateral_ <br />Abutting Lot Line <br />N( S�, W, <br />iL. , G �-� <br />�Z.��� <br />� 5 <br />Apnroved By �' �"�--NN��'y '"""f <br />City Engineer <br />i55�Edsv L� ��.,c.�,�,�,.a,J . <br />� <br />Inspection By ���-��< <—� _ <br />Date I nspected_��� �'� 7 z <br />n : � , n <br />N0. � � `i �: . <br />- ;. . - _ <br />� "�x,.��s �r�ifi' �'�',�' f ��: :.> <br />