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everetl <br />� <br />City of Everett <br />Sewer Application and Permit <br />CHART <br />Cy I —�' 8l � <br />�'•�j POS."C�1� t I V M M5 <br />�0. ZG95O DATE �'� �-8� �—. <br />Service Address �� � S � �� /'�---� Utility Account No. <br />Billing Address <br />City, State, Zip — <br />Owner (Mortgagor) <br />Billing Name <br />Connection By G'�` n� �Vr �e'i"r <br />Permit <br />Connection Charge(s) <br />Total <br />Sig110d Customer - <br />DESCRIPTION: Sewer District <br />Lot � �� Block Monthly Sewer Service <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Trunk <br />Type Permit: <br />Remarks: <br />I� <br />6 <br />IMPORTANT! <br />CALL 1-500-024•5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL259S871 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutzing Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engineer <br />issued By D c N M� I1f Y <br />� <br />Inspection By � <br />Date l nspected� � y <br />No. zssso <br />UTILITY E31LL!NG <br />