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� CHART NO., � • L <br /> everett i <br /> e �� 5 ��=� � � � <br /> � <br /> City of Everett I <br /> Engineering & Community Services <br /> { Sewer Application and Permit � ' <br /> � N� ?_ 1969 �,�rE 1- ;� % - %'I ' <br /> Service qddress �%'U:� ="' r � r; �_ Utility Account No. <br /> Billing Address �' `}= <br /> Permit Fee � �J <br /> City, State, Zip -: '�� � '.r Connection Chargels) I <br /> J <br /> OwnerlMortgagor) �,= ,^i��, ' . �r. :'",�:•.r/, TotalFee r���- � <br /> Billing Name <br /> p � <br /> Connection By_ /E�/� � �; � , �/a��%; � <br /> �/ / �� ,� <br /> '' r� ` � :L � , � , � <br /> Address ` � � f :>,i9�•V-f -4 ' � � :�. Signedi�,G��a'fl.f�,�.�:..t`�i�';fi' <br /> f— ./ Custumer � <br /> Phone �' � �; c���, <br /> DESCRIPSION: I4 z Sewer District <br /> Lot�. ' Block �4z- , u <br /> P�at—�'''LJ-\T , `�f= n J+' 1(�� - L%� J Z Monthly Sewer Service _ <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: �� �h�, �` Trunk <br /> Lateral <br /> Remarks: <br /> - Abutting Lot Line <br /> N, S, E, W ft. <br /> f APProved By �Ld j,%l %� :iii/,�i G <br /> 2i�y Engineer <br /> � Issued By � _ C � �L`" / ts c <br /> ' �— <br /> I <br /> � Inspection By�/���x-t�---�-' <br /> � y�- ' - Datelnspected J o�� 7 7_ <br /> ' SEESKETCH ATTAC� NO. <br /> � :i�lSPL"CTIOf�i . <br />