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1 <br /> _ -. , <br /> . . <br /> CHART N0._ - - <br /> everett �.: ., _ , �- --.. <br /> �� (l �� � <br /> . � L� <br /> � ��� ��� <br /> , H � i�u� <br /> City of Everett _............__ 1 <br /> I ;Y 0- [';�L-R�T-� <br /> r <br /> Sewer Application and Per�mit ' <br /> No. 24659 DATE Q Co .3 � -'7 <br /> Service Address a � Utility Account No. <br /> ir' <br /> Billing Address � -�*-� _ Permit Fee �D � <br /> City, State, Zip y 'v D Connection Charge�s) — I <br /> .. 0'� I <br /> � Owner (Mortgagor�_ - Total Fee �D i <br /> IBilling Name , ✓� L-�^�� <br /> / <br /> Connection By � <br /> I <br /> Address Signed <br /> Customcr <br /> Phone <br /> DFSCRIPTION: Sewer District <br /> Lot�` - !7 Block � <br /> Monthly Sewer Service <br /> � Plat_-_�� <br /> Unplatted Desci iption Monthly Sewer Constr. <br /> � Trunk I <br /> � Type Permit: <br /> � Lateral <br /> I Remarks: <br /> Abutting Lot Line <br /> � �UC C � CO�e W ��` �. N, S, E, W ft. <br /> i <br /> i <br /> � Ct S� (� f'1 GYc'P �� � � <br /> � �j 3 I-�.,..�a.r w y�� PVC- Approved By ✓�L—%� /��.�rv` <br /> I � City Engincer <br /> i � <br /> I — Issued By �' L�� <br /> 1/ <br /> 1_ Inspection By,- �'�� � <br /> Date I nspected /��y�� � <br /> SEE SKETCH ATTACHED N�• Z�6`79 <br /> i <br /> INSPG:.TIO�� � <br /> � <br />