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CHART NO. <br /> , everett <br /> e : ,� <br /> .� _ <br /> i �J <br /> l ! <br /> 1 ! � : <br /> City of Everett �4 �7' lL <br /> . . . �� �, � � ,Y, ` <br /> Sewer Application and Permit <br /> i [� <br /> j NO. 247�T 1 DATE 3�'��/iP/ <br /> i <br /> IService Address 3 � Utility Account No. � <br /> I Billi�g Address � �1 Permit Fee �� <br /> � City, State, Zip � a- ��o � Connection Chargels) � <br /> � � <br /> i Owner (Mortgagor) Total Fee � <br /> ' Billing Name <br /> i � <br /> Connection By � � � � , <br /> Address Signed <br /> Cust mer <br /> I � <br /> Phone <br /> � <br /> DESCRIPTION: Sewer D`;trict , <br /> Lot S�– S y Block � � 'z � _S� <br /> Plat��� .�—� Monthly Sewer Service <br /> I Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: ��y.,.��s,..��� <br /> � Lateral _ <br /> i <br /> � Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> � �i APpfOVOd By Ciiv Engineer �� <br /> I <br /> Issued By p ' �` I <br /> i <br /> I <br /> I �, <br /> Inspection By � �6°�T` I <br /> Date I nspected S�'�-1 Y I, <br /> i SEE SKETCH A7TACHED P10• L4771 II <br /> INSPECTIOhI II <br /> il <br /> � _ <br /> l - <br />