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everetl <br />e <br />City of Everett <br />Engineering & Community Services <br />CHART NO. i '! <br />ass T�� <br />C-i,3 - 7 y <br />/raw* <br />Sewer Application and Permit <br />NO. 2 1 9 7 1 DATE/ "�7��/ <br />Service Address 3��''_, ��? tNrt+� I�Je <br />Billing Address S <br />City, State, Zip_ Ein t1 teT (-j FN �jts z�7[� <br />Owner (Mortgagor) aid Jfd fl t+ i i `� <br />Billing Name_ <br />Connection <br />Phone_ <br />DESCRIPTION: <br />Lot (( Blork_11 <br />Plat e 1 J,c / <br />Unplatted Description <br />Type Permit: 1 - t rt a LTt drt <br />Remarks: <br />SEE SKETCH ATTACHED <br />IidSi'cCTION <br />Utility Account No. <br />Permit Fee jQ')o <br />Connection <br />Total Fee 30 �J <br />Si <br />Sewer Dist <br />Monthly Sewer Service S `� <br />Monthly Sewer Constr. <br />Trunk ; <br />Lateral- �-; <br />Abutt ng Lot Line <br />N, S, E, W, <br />Approved By_ 41 c k'j> /1r'f/i'-1we <br />>Crty Engmecr <br />Issued By %/rc- �l c.l r. <� <br />Inspection By_ '� —! ��.ac�� <br />Date Inspected_ ���'�/%� <br />N0. 21971 _ <br />