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evereti <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22783 DA" <br />CHART No..A <br />99 <br />Service Address ✓ r Utility Account No. <br />Billing Address F1�f '✓ '" Permit Fee <br />t _ <br />City, State, Zips / `:- j/ Connection Chargels) <br />90 <br />t <br />Owner (Mortgagor)! <br />t <br />Billing Name <br />t <br />Connection By <br />Phone _- S"z - // Z <br />DESCRIPTION: <br />Total Fee <br />A <br />Signed .'14 <br />Customer <br />Sewer District -3 - <br />Lot Block --Monthly Sewer Service <br />Plat j r-•i ;z j 1 i .>p.� .'/4 ? <br />Unplatted Description Monthly Sewer Constr. <br />t <br />Trunk 4, -y 0O <br />_, .� <br />Lateral r �� <br />SEE SKETCH ATTACHED <br />IhJSPEC 'I ION <br />Abutting Lot Line <br />N, S, E, W <br />ApproVeb By - �d <br />' City Engineer <br />Issued BY ` / <br />Inspection By <br />Date Inspected 'S- 7— 79 <br />• <br />