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, <br /> � <br /> _I <br /> CHART NO. <br /> I everett I <br /> �' l��S l�Ip i <br /> City of Everett � � � � � II <br /> . . • v v � <br /> Sewer Application and Permot � <br /> � <br /> � <br /> N0. L�3�V DATE T,7��! X �'" _ I <br /> Service Address �� � S C� Utility Account No. pc i <br /> BillingAddress l!� �7� �5' �d..�-' - `� PermitFee �a � <br /> City, State, Zip�,- ���� �L����o3-U--� Connection Charge�s) I <br /> _�"� i � a�.,_. <br /> Owner (Mortgagor) � Total Fee .30 <br /> � /% <br /> Billing Name � �' <br /> i <br /> Connection By ' - — <br /> I Address Signed ' <br /> Customer <br /> Phone �S� — Ly�� �- <br /> ' DESCRIPTION: Sewer Dis-trict <br /> Lot � ' y� _l� Block � � � Monthly Sewer Service <br /> Plat �...._,�?� ��- � <br /> Ur.platted Description Monthly Sewer Constr. <br /> � <br /> f _ Tru i�!� _—. <br /> i- - <br /> l"ype �'_ �/' �o-,-. _ <br /> � Lateral <br /> ) -- �a _ ` � , <br /> r�t,r��� � �O 3 � <br /> Abutting Lot Line <br /> o T .C-Zc-l�.-�-�-C' N, S, E, W 7'� ft. <br /> � / <br /> — Approved By� �r �� <br /> �iv ���� � <br /> � c ' <br /> � — � Issued By � - ��-- �I <br /> I <br /> � <br /> � \ <br /> � I I 1 ' <br /> Inspection By � ���`�/��f� , <br /> �, � <br /> r Date Inspected '" 7� � �� �`� � � <br /> SEE SKETCH ATTACHED N0. �4�.I.� I <br /> � <br /> i <br /> li�!SFfil-1 ION I <br /> � <br />