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everett - <br />e <br />City of Evmn <br />Sewer Application and Permit <br />NO. 23354 DATE /A? /z 9' <br />CHART NO.- .�S-zy -y <br />Service Address O . Utility Account No. — <br />'s 7-45F-0 <br />9" <br />Billing Address 45-S-33 0 Permit Fee/ <br />City, State, Zip � (O�� Connection Charge(s) [7.3 <br />Owner (Mortgagorllc __.0 ,r //a Total Fee _ <br />Billing <br />Connec <br />Address. -� <br />Phone2L i'b%/yd <br />S <br />DESCRIPTION: <br />SEE SKETCH ATTACHED <br />'- <br />Signed - ' <br />{r Cmlom r <br />Sewer 6ittrict o7D I <br />INSPECTION <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />I° <br />Trunk /•/✓— �' y0 <br />e <br />Lateral e? S 3g✓�� <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By �Y /l�� �- t �% <br />City Engineer <br />Issued By <br />Inspection Bye 2. <br />Date Inspected - .5 - 7 c% <br />No. 23354 <br />