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City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. 22101. DATE �,? �7-7 <br />Service <br />Billing <br />City, S <br />Owner <br />Billing <br />Connection By— <br />Address— r / �� c <br />Phone 4 <br />DESCRIPTJON: <br />Block— <br />Plat �' ! <br />CHART NOV� <br />A011W <br />Utility Account No. 3 -- <br />0 <br />Permit <br />19 <br />b0 <br />Connection Charge(s) �2 <br />Total Fee 30 — <br />Sig d <br />Customer <br />Sewer District �� 22Z — <br />Monthly Sewer Service -2 ' s� <br />Unplatted Description Monthly Sewer Constr. <br />�) + <br />Trunk " ; 7 <br />SEE SKETCH ATTACHED <br />INSPECTION <br />I <br />Abutting Lot Line <br />N, S, E, W <br />Jl- <br />ti.i_ �...<_,..,. <br />Approved By <br />City Engineer �! <br />Issued By l'`7' <br />Inspection BY—A0 �! <br />Date Inspected <br />Y <br />N0. 2210- <br />