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� <br /> i. � CHART NO.� � ��� -S <br /> ( everen - <br /> f �/�, �y `� � O <br /> � e; <br /> � City of Everett <br /> � Engineering & Community Services <br /> f Sewer Application and Permit <br /> , <br /> � NO. :� .L i :' tj DATE � Z C. 77 <br /> Service Address z"Z'� � �-- C���-� ��� Utility Accouni No. <br /> Billing Address �J���`�� � Permit Fce ����� <br /> City, State, Zi�-U��'�;'T7 �:SzQ � Connection Chargels) <br /> � <br /> --�ner (Mortgagor)� • �� C=����f���' Total Fee � G�`--'� ; <br /> c.�_ <br /> - Billing Name � r��' i{- � <br /> Connection ByG � � � ��' �"���r � <br /> i <br /> Address Signed �--'�-11-- ���e��-�;,/�c' (� � <br /> Cusmmer <br /> Phone — � <br /> DESCRIPTION: C Sewer District i <br /> Lof�-a:�- �- Block�'� Monthly Sewer Service <br /> Plat�t--T�.�+ti�G�.�'(' �F-�+..� <br /> Unplatted Description Monthly Sewer Consir. <br /> ���� � Trunk <br /> 'Type Permir. <br /> Lateral � <br /> Remarks: �QQ���z� � <br /> .�-� Abutting Lot Line <br /> � <br /> ���/1+ ir�-a.e.u� �Sa- 05/ .r/� _t�l N. 5, E, W fL , <br /> �T� ��� � <br /> Approved By� �I�l-�h-`( t-.-':C-i <br /> Gry Engineer i <br /> Issued By l� • �i-��-L-L�� �/y`-� � <br /> ' Q �? � I� <br /> k Inspection By nL��.A -�'tLN���" <br /> � Date I nspected ��- h,j -y� <br /> 9 <br /> � SEE SKETCH ATTACHED NO. <br /> � If�;_;I ". Cl I �f; � <br /> � , .. ,�.�.,.��: , . <br />