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evereri <br />� <br />City of Everett <br />Sewer Applic4tion and Permit <br />No. 23041 <br />DATE !�— � %—� % <br />CHART N0. /� / �G i-�� <br />.� � <br />,••;-_-.,in <br />Service Address `^ }� �� � u� ,a�.r��Utility Account No. ���9 <br />c� <br />Billing Address �_ �� �r! �'G Permit Fee �A i _ <br />� � <br />City, State, Zip % .�.t .� ��__� ��o `�'> Connection Chargels) `i90 �� <br />.� - � _ � // i1� _ ., o% <br />Owner <br />Billing I <br />Connec <br />Adciress <br />Phone � 5 -�- <br />3s - <br />DESCRIPTION: <br />Lot �3 Block <br />Plat ��l't�ci �J � � � <br />Unplatted D�cription <br />F <br />Signed-- <br />o�.����„ � - -- --- <br />Sewer District y .�6-�� ---- <br />Monthly Sewer Service � • �`� <br />SEE�K�TCH ATTACHED <br />Monthly Sewer Constr. <br />. <2 .5` d�---- <br />Trunk �� /od <br />o�— <br />Lateral .� •%S ��O <br />Abuttiny Lot Line <br />N, S, F, 1V_ —_ ----ft. <br />�/�-� j� � <br />Approved By ���,L�'��y�=-:-.� <br />Ciry Engineer � <br />� /! <br />Issued By � ` " ��'�.-- <br />Inspection By � a`-� — <br />� <br />Date Inspected � � � / __ <br />N0. �30��. <br />