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CHART N0. <br /> eve�ett <br /> � � <br /> City of Everett <br /> �' ��,��� �.'7.� _ `� <br /> • . �BS'��.��I� "� � �7`; � <br /> Sewer Application and Perm�t <br /> N0. LbyJ :S DATE ,� - .3C� • F�� <br /> Service Address 2 � � � l-�.O Vv� hA Y C � Utility Account No. _ <br /> Billing Address Permit Fee <br /> City, State, Zip_ Conn=ction Chargels) <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By � I "�"J b � F U C.Y P. T �' <br /> Address_ Signed <br /> Cusmmcr <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot � � Block <br /> Plat Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: +. <br /> Lateral <br /> Remarks: <br /> ' Abutting Lot Line <br /> �� L' ` N, S, E, W ft. <br /> � ' /� � <br /> Approved By_ _ <br /> City Engineer <br /> IMPORTANT! s <br /> CALL 1-800-424-5555 48•HOURS I55ued By � �� � M-( � 1�-' r <br /> PRIOR TO DIGGING <br /> CALL 259-8811 FOR INSPECTION <br /> Inspection By <br /> Datelnspected <br /> �i �.� (_lrn <br /> SEE SKETCH ATTACHED NO. �- t� �' ^� '� <br /> CUST0��:7G�i COPl' <br />