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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />J <br />` J � <br />CHART N0. �� — �1 � � <br />�'O s � G i7 z� <br />Sewer Application and Permit <br />N0. �� Ii!� DATE 3' �`"� - <br />Service Address ?��'�' ���"'� ��� � S � nE <br />Billing Address ���f»�� <br />� <br />Utility Account No. <br />Permit F <br />City, State, Zip �'�V �� �'��� �/���5 H. 1��� Connection Charge( <br />Owner (Mortgagor) I� �' "s�� nr ', 1-'��� =- Total F <br />Billing Name � � � � y�'� <br />� ,� � <br />Connection By �%� �'I" rJ�=.�r_ ; � <br />DESCRIPTIO�I: <br />Lot � Block ��� <br />Plat rh - ."s � � , ry , � r,. �� • ; _. <br />Unplatted Description <br />Tvna Permit� <br />/�-�F'�NC=. <br />Signed <br />C._._t_ CJ �- ��-%(` G� G <\R� <br />Cus�omer <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 />� . � <br />� 3i k�.a:sYlu.wu"i 4h° +"a � m ,:: �'; J+ <br />� l <br />� _ __ '_.Y�x i°�'� i ii �L <br />4pproved By .�i �+�-,•�...�...r., <br />Ciry Engineer <br />S9 � + !r <br />Issued By �''' �'�-{'�'Jt`'r <br />Inspection By � <br />Date l nspected �r � ^ Z. % <br />NO. sl ''i ;` , <br />