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everett <br />� <br />City of Everett <br />Engineering & Community Services <br />Sewer Application cand Perrriit <br />, <br />`��'-`'�'� DATE /'/• �� /fj%�,- <br />NO. __.�,_ . <br />� -"� r- -� <br />CHART N0. " ���� `— �� <br />� d S �� � <br />/L " -,S' - 7 � <br />�s�' � <br />Service Address <br />� ��� � >' `�"':: � • Utility Acco�nt No. <br />� <br />City, State, <br />Owner (Mortgagor�_ <br />8illing Name <br />! ' ` ' ''�. <br />: .r . '�� - � � ; <br />Connection By � — <br />� :i <br />Phone <br />DESCRIPTION: <br />Lot Blocl; <br />Plat <br />Unplatted Description <br />Permit Fee " `—'—" <br />Connection Charge(s) �'"�� <br />Total Fee ''' '`� <br />Signed � — <br />Customer <br />� <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />SEE SKETCH ATTACHED <br />-n-r�-,.-•--•--�-_^"^'�,?•,�r,—.,;_ _ <br />-- IPISPE�TI06i <br />: ,(,. <br />Approved By� - -�- <br />City Engineer <br />. . ��.: ,/� . <br />Issued By - -- � <br />Inspection By��"1 � ""`"'" <br />Date i nspected / "L - `� ' % �' <br />N0. ,- 1i <br />�T. . ..f . . i...�A�� �I <br />