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"� <br /> � £ <br /> � � � I <br /> a�� F <br /> +� yw <br /> y �� CHART N0. <br /> "y� everett <br /> � Nhtl <br /> VJ H� � _ � <br /> [■J O� • <br /> C H �r o } Q ��s', ,;+� <br /> Q� g - _ _ � � �� P�STING32-��- 5 � <br /> City of Everett <br /> ` ; ~; :, ~ .� <br /> �y� ,- . � � <br /> r' Sewer Applicati�an and�P�r�� , ;- <br /> � <br /> , <br /> �J � � . . 1� LJ •1 �. (� <br /> gV1H ' i„ '`��' � � �s, '�,` � c 4� <br /> "" � <br /> c�Ctn � 3/1��92 � � �. r. � '� mc:� <br /> �t�� NO. 28640 DATE <br /> H o t�i� 3G22 Everctt Avc Utility Account No. <br /> Service Address <br /> Billing Address �'��� 102? <br /> "•erPtt W'� 9`�^�G Permit Fee $ �`� � 'U <br /> City,State,Zip — <br /> Owner w � "-` ` "� r Connection Charge <br /> Connection by Trunk $ <br /> Address Lateral S <br /> Total Connection Charge $ <br /> �� � Phone Utility Development Fee <br /> �� Legal Description: Water $ <br /> { � � Lot Sewer $— <br /> �� �� Block 7otal Developmenl Fee $ <br /> I <br /> Plat <br /> I �� <br /> i ��� Unplatted Description: Sewer Bond District <br /> I Abutting Lot Line <br /> � 1�1 N, S, E,W ft. <br /> IType ot Permit �_�Uti Approved By <br /> � '�'+' Remarks Issued By _— <br /> Customer Signature <br /> IMPORTANT! <br /> �� � f,L /�;., <br /> CALL 1-800-424-5555 48-HOURS ��� ��i,� �- �l" Z <br /> PRIOR TO DIGGING � �'� C`t <br /> Inspection By �� , <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected <br /> SEE SKETCH ATTACHED No. 28640 <br /> INSPECTION <br />