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everett <br />e <br />Gty of Ewrett <br />Enyi�eariny & Community Services <br />Sewer Application and Permit <br />No. 22174 DATE f %r - 7,1 <br />� ,, s <br />ServiceAddress �- �-? ' %�--°2�'�` a •.1.-� ':'.-r. <br />� <br />f <br />Billing Addren �'r" �' , <br />� / <br />City, State, Zip �s ..;`f/ , � �£`- /�•-� � <br />owner (nnortyayorl �l"—',:,� ,.�:..� -,^ .".� ,=�'".� <br />;� — <br />U <br />Billing Name ._�-*- � %• •.1=�' <br />� i <br />Connectio� BY ' _r• �,, ..> .. r.'.f:_,� �, " <br />Address ;% .! ,: �: j,�.� .;,;� <br />� ,�_T <br />Utility Account No. <br />^`� � 1 <br />Permit Fee_ tE: =,'��''� � '-'�"-�-- <br />C,onnection Charge(s) <br />,-.a <br />Total Fee � `'� r <br />`'� � � /I:; i �.�� <br />Signed �`'�'" � <br />custom.r <br />DESCRIPTION: Sewer District <br />Lot %� �= - Block ����' r Monthly Sewer Service <br />Plet /r.:� � , i� '�.x,� . r .� _ <br />Unplatted Description Monthly Sewer Constr. <br />Trunk <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By ` I •A%'.=�- =! <br />Ciry Enpinex � <br />'Y .. • <br />Issued By 'r'�'"-+ � <br />I nspection <br />Date I nspected <br />rvo. 22174 <br />