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CHART N0. y � �' � '� ` �' <br /> everett � <br /> � � 1 ,,� <br /> I��}/f.� <br /> � ,; , <br /> City of Everott L' " �' <br /> Sewer Application and Permit � <br /> N0. 24689 DATE <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 / , _..,�-- : � <br /> • • Signed �, � / f � I <br /> � Address_ �- c�s�o�„e� <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot�-- Block�— Monthly Sewer Service <br /> Plat �� * e c...r* — <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: qbutting Lot Line <br /> p Pc ro N, S, E, W ft. <br /> o�.--ti <br /> o -� <br /> � Approved By <br /> i ineer <br /> Issued By <br /> Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED N�• 24689 I, i <br /> INSPECTION I <br /> ` . <br /> I <br /> `___ —_ <br />