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:� <br />��� <br />p�x <br />�YHxc~i� <br />H Z� <br />fC C] <br />H :V <br />"�� H'� <br />fA H <br />�xp <br />H C7 <br />O �-+ <br />H�8 <br />(�] Y (❑7 <br />9 H [� <br />y <br />t HH <br />g `� <br />oCN <br />� r� r <br />zy� <br />H O C/� <br />e ett <br />City of Everett <br />CHART NO. ''�� - Z�� l � « <br />j��st C� <br />in /� � <br />Sewer Application and Permit <br />No. 28094 DATE �- 1��^...�--�Q � <br />ServiceAddress ���� �"�rA/� [�— <br />Billing Address <br />Ciry, State, Zip <br />Owner <br />Connection by � f�1 � Y �1i� <br />Address <br />� <br />Phone <br />Legal Description: <br />Lat <br />Block <br />Utiliry Account No. <br />Permit Fee $ <br />Connection Charge <br />.Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />Plat <br />Unplatled Description: Sewer Bond District . <br />Abutling Lot Line <br />N, S, E, W n. <br />Type oi Permit R� .. r� o � f�o /) � C' O Approved By <br />Remarks ���' �o �o P 1-F...r, isiB1�/ Issued By �^ ^� �' ��e � <br />" Customer Signature <br />IMPORTANT! �� �� 9 � d <br />ss@. %. 3'd @ <br />CALL 1-800-424-5555 48-HOURS �/�� N. o f /)'T �� ��� <br />PRIOR TO DIGGING <br />Inspection 8y <br />CALL 259-8810 FOR INSPECTION ,_ �. c <br />Date Inspected / � <br />SEE SKETCH ATTACHED <br />UTILITY BILLING <br />No.28094 <br />