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c <br /> CHART N0._!/' �'° - �'%- �� <br /> evcrctt I � <br /> � , . : <br /> � <br /> �. � _ > <br /> � . <br /> City of Everett �' _ _ <br /> Engineering & Community Services � � • <br /> Sewer Application and �errr�it �� <br /> �:. <br /> �_ <br /> NO. �18 b 5 DATE 7/�� ��� <br /> � r-' <br /> Serv�'e Address_�90 � !_� - �� �-r--t- Utility Account No. <br /> o v . -=�, �T 7i 3 �-�' <br /> Billing Address -�v � �' -�= ^v�-- ✓ Permit Fee � � <br /> -,�� � ' 1 <br /> City, State, Zip �' .�'-�• ��` •/•✓�� %%=Z f,3 Ccnnection Charge(s) <br /> i; / . , , e� <br /> Owner (Mortgagor) - � � - �' I �_.� �i�-':i��'otal Fee 3� —� I <br /> / % / - %' ,r <br /> 1 <br /> Billing Name 1 '� �-� f . � ' i� :.�,� , <br /> � _�.. 1 ,�... ;� r,:_..7..�_ j, r ✓�.,.,.. 1 <br /> Connection By ��-�.-, • _� � "' - ,� 4� <br /> j .• 1 <br /> � ,� '__.... . > iy <br /> Address Signed "�_� _, %��. a.� ••y,�r,�.:� <br /> - -� � � �_ L//r� Customer ' y <br /> Phone •> h <br /> I <br /> f <br /> DESCRIPTION: Sewer District � <br /> Lot �3 — / � Block � d 9 / <br /> Plat r-�.t.--�.� �-Z`�"" Monthly Sewer Service !�� -� �• --,� I <br /> Unplatted Description Monthly Sewer Constr. <br /> "i runk <br /> Type Permit: i/-e......— ,. �.-�� >-.J • - � <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line , <br /> N, S, E, W ��RTNF^' p ft, � <br /> . Approved By� �1f—,; � <br /> ; ,,�- . <br /> CiryEnginecr �� I <br /> �"f � r� <br /> Issued By ��'/..�.;, �.- c.. r'`_.i-......_.. I <br /> Inspection By <br /> o Date Inspected <br /> SEE SKETCH ATTACHED � ` " <br /> N0. � .� c) �: :: <br /> INSPECTION ----.�.._.�. --- --_ ---__ _._ . <br /> r---_ _. ._ . . .. . _ _ . . ..� c- <br /> _�_.._._....,__.._.�.��.._..�__..i tL_� ._�.�- _.�---------� I <br />