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; .� - ,; / - 1 .� � �' CHART NO. �-� � �= -� �-- <br /> everett . ^ .--�� � <br /> ��/ G% <br /> � ; -��'6 <br /> / <br /> City of Everett <br /> �f � <br /> Sewer Appiicat�or� anc! Perrr�it <br /> N0. G�233 cUl'% DA7E !/ �' '_� <br /> , <br /> I <br /> IService Address - - - __ Utility Account No._ __- <br /> Biiling Address � � _ Permit Fee. — <br /> City, State, Zip � - � ' Connection Charge�s) <br /> IOwner (Mortgagor) - - _ Total Fee __--_ — <br /> I <br /> Billing Name__ -� - <br /> i� Connection By_ � -- <br /> i Address Siyned_ — ----- - <br /> r.us�onu„ <br /> Phone " <br /> DESCRIPTION: • Sewer District__ _ _ _ __ -___._- —_-- <br /> Let_ � Block pqon[hlySewerService____— -__- <br /> Plat . - <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk ___ <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> ALutting Lot Line <br /> iV, S, c, �'� -- -- ft. <br /> — Approved By _ _ _ <br /> c,�v e�,�������„� <br /> _ , . . 15sued By ---.. _._ — <br /> _ � <br /> — Inspec[ion BY i ' �— —1�-=�'-- -- <br /> .� <br /> -- — J Date Inspected__�� ��C' �V � � � ��— <br /> Sk=E SKETCH ATTACHED No. 23233 <br />