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CHART NO._ <br />everell <br />e <br />City of Everett <br />Sewer Application and Permit <br />/ <br />NO. c53?`3 / DATE <br />-; 11/I/r <br />Service Address � ! T / Utility Account No. <br />1 Filling Address r:;2 /E �_ Permit Fee116 <br />;r <br />City, State, Zii 14,11 '-ZO 3 Connection Charge(s)— <br />Owner (Mortgagor)—Jr/�// / s%6 al Fee �l' <br />Billing Name <br />Connection BY <br />Address Signed L /-y t wixU,r _ <br />Customer <br />Phone <br />DESCRIPTION: Sewer District <br />Lot. Block <br />Plat Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit_ Trunk <br />Lateral <br />Remarks: <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />City Engineer <br />IMPORTANT! <br />1!ssuecl By <br />CALL 1-809.424-555540-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />i <br />Inspection <br />Date Inspected <br />SEE SKETCH ATTACHED No. 253�3 <br />INSPECTION <br />