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CHART N0. <br /> f erett <br /> � <br /> City of Everett <br /> Sewrer Applicaticn and Permit <br /> N0. �7 I �' 7 DATE I- �-I� 9 I ..- <br /> Service Address � � ._.) �.�-� Utility Account No. <br /> Billing Address Permit Fee <br /> City,State, Zip Connection Chargels) — <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By��L2�—�Lt' Y'��'t <br /> Address _ Signed <br /> Cwmmer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot Block Monthly Sewer Service <br /> Plat <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: q,,,�a,r <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> � N, S, E, W ft. <br /> —�z�– " c <br /> , f�-r� / <br /> � d � d Approved By <br /> �i '�Q Oi� J C p ��0 D 8 �� City En9ineer <br /> � d G / <br /> IMPORTANT! �� �� ��� �,. <br /> Issued By ��, —L�1 <br /> CALL 1-500-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-881 OFOR INSPECTION � <br /> � <br /> Inspection By <br /> Date Inspected �- �-3 - 9� — <br /> SEE SKETCH ATTACHED <br /> rvo. �7 � �7 <br /> �U:;i i;:�.:1=1� C��FY <br />