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_ CHART N0. . .1, -- ( _( - �'_'�;_.' � <br /> everett <br /> � p � , --� i; �_ <br /> i `—' <br /> ' City of Everett . <br /> : .�.ngineering & Community Services <br /> i <br /> ! SE�v�r�r Ap�lication and Permi� <br /> i <br /> � <br /> N0. � ! ?, �' R) DATE �� I7 2 ��77 <br /> ; -�y <br /> Service Address '� %"%'�"- 1--�=.��`-�� -�.�' r r� Utility Account No. <br /> ; <br /> Billing Add�ess _ =L��'�� Permit Fee {\� f.(`1� <br /> � �. �4_ 7 <br /> i City, State, Zip�--��`��" -�-- �- C � Connection Charge(s) <br /> i + <br /> Owner (Mortgagor) •--- �+-� f-��-5=-=-< < — Total Fee t�-� Cl`�C._ <br /> G - <br /> ! Billing :;ame �--'!�`��L:. <br /> ! C;onner.tion By � � - <J� ���+.y"z �7-r- <br /> i <br /> i Address Signed � E-�'� L ��n<'-` �(� (, <br /> � Customer � <br /> � Phane <br /> � <br /> � DESCR;PTION: Sewer District <br /> � Lot � '�_�= Block j�'� <br /> � Plat � 'r'a�� �>T p Monthly Sewer Service <br /> � <br /> Unplatted Description Nlonthly Sewer Constr. <br /> I <br /> � <br /> E TYPe Permi:: ��-���1 � Trunk _ <br /> � _. <br /> Lateral <br /> � Remarks: <br /> Abutting Lot Line <br /> � =-�-,�, N, S, E, W ft. <br /> �r�l c-�•.- S !? .� y . [ <br /> 6 <br /> � -i%- /17•.I�_:t�� /�m i� t� t <br /> iApproved By� ��f:..(--'-']I ti1 �� <br /> I — Ciry Engineer T— <br /> I <br /> � Issued By • �,OLL�'.J ,E}--�1 N <br /> I <br /> � <br /> I <br /> n �� Inspection By C�-u�� s��:.-'!-1e <br /> ' Dace Inspe,:ted_ v -h 3 _ / � <br /> 0 <br /> � SEE SKETCH ATTACHED N0. � i. � c_ '• <br /> � ��� i�� <br /> . <br /> � y �.� i :� � ,.:�• �.,. . <br /> . � . .._. u t� . .i . ��.LRL� ::� � _.. � ....� L~�H� �i � �ey� l �l. _ 'I� Y <br /> ..� �� .. . _. _, <br />