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j CHART N � �
<br /> everett
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<br /> ; ��,����� -
<br /> , City of Everett � I
<br /> Engineering & Community Services \
<br /> I
<br /> � Sewer Application and Permit � .__ �9 — 7�
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<br /> ' N0. DATE -� - %� ?.�'
<br /> Service Address --' J� .� � �_ Uti!?ty Account �o.
<br /> ' � ,/, ��: r c. •
<br /> Billing Address - • ��_ L.-,T / J � Permit Fee -��
<br /> j City, State, Zip. - _ - �- / !u � / �,;',�Connection Charge�s) ���^�
<br /> _''� � _ ' J :�il
<br /> iOwner (Mortgagor) � � - ✓ % • Total Fee -% ��
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<br /> i Billing Name �
<br /> Connection By
<br /> Address Signed
<br /> � Customer
<br /> i Phone- �7 �- '7-Sy�- _
<br /> i ,
<br /> i DESCRIPTIpN: Sewer District
<br /> i -���/,�, �
<br /> � Lot � �`��-? Block �= �
<br /> � Plat � , �' . Monthiy Sewer Service -� '�U
<br /> � Unplatted Description Monthly Sewer Constr.
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<br /> fType Permit: "�'� -- ' � Trunk
<br /> � ' � ^-r�-•- ,: -..v
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<br /> ' Lateral
<br /> t —
<br /> ; Remarks:
<br /> ; Abutting Lot Line
<br /> N, S, E, W ���` �, ft.
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<br /> I ,. 1/ '
<br /> � Approved By� - �
<br /> �
<br /> j Qty Engineer
<br /> /,
<br /> ; Issued By ' __ f
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<br /> � �� `r ,---
<br /> Inspection By ��d�%��=<--�
<br /> j ,� Date lnspected_ .��-Z /�7�
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<br /> SEE SKETCH ATTACHED N0.
<br /> � --T. ��isi�rr,?i�,°,� ,�._,_,�„�.,.,.,.,�--�,�.,_ ��___..___ ._
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