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Lr <br />City of Everett <br />Sewer Application and Permit <br />CHART NO. <br />No. 23065 G flig DATE T 1T— <br />Service Address. h Utility Account No. <br />Billing Address `Permit Fee -- <br />City, State, <br />Owner (Mortgagor) <br />Billing Name <br />t <br />Connection By <br />eaaroee <br />DESCRIPTION: <br />Lot <br />Plat <br />Connection Charge(s) <br />Total Fee <br />Signed -Lv ✓ /-' i" <br />Customer <br />Sewer <br />Monthly Sewer <br />Unplatted Description Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />i N S 'LLI IUN <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved by <br />City Engineer <br />Issued By <br />Inspection By � � '// , %�l2 ` " " <br />Date Inspected -/" 1;11 7- <br />No 23065 <br />