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CHART NO.y 0 • 2°i - S <br />everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23592 DDATE �YO L <br />Service Address /�fnl�t — Utility Account No. <br />Billing <br />City, S' <br />Cwner <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot Blo <br />Unplatted Description <br />SEE SKETCH ATTACHED <br />j;tu <br />Permit Fee_ 1-6 <br />Connection Charge( <br />Total <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By <br />City Engineer <br />Issued <br />Inspection By — — <br />Date Inspected yy <br />No. 23592 <br />INSPECTION <br />