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�. <br /> CHART N0. � � � i� � <br /> everett <br /> `� _.. � <br /> , .^ .:� �'< . �/ . <br /> � ` l - <br /> �O <br /> City of Everett , .� �,-, <br /> Enyineering & Community Services , <br /> Sewer Application and Permi+ <br /> Np, i DATE �— ` / � � i <br /> _ j�f2/ <br /> Service Address_�� ` � Utility Account No. <br /> � .. . U ✓ <br /> -'' � �' - ` � /�% � Fermit Fee l l� '� <br /> Billing Address � � - <br /> City, State, Zip r 1.�� • `f'' • �J J. Connection Charge�s) '`—' <br /> Owner (Mortgagor) J' Tot��l Fcc---__--- .�.— — -----— <br /> Billing Name � <br /> i <br /> Connection By <br /> Address Signed _ <br /> Cusicmer <br /> Phone - i � % <br /> DESCRIPTION: Sewer District <br /> Lot � Block " y� <br /> �; Monthly Sewer Service__..______ ___ __ <br /> Plat ' � -� <br /> Unplatted Description Monthly Sewer Constr. <br /> Type PermiL �' - f� � Trunk _ <br /> Laterel <br /> Remarks: ` <br /> Abutting Lot Line � , - <br /> N, S. E, W / -- --- -- it. <br /> Approved By'` • - / <br /> City Engincer <br /> 4 � ' , � <br /> Issued By ' ' -- � <br /> � 1 <br /> � <br /> Inspection By� /, v_'N��'n ��-%cLti -i�� <br /> Date I nspected_ -5 ��-/� <br /> a <br /> SEE SKETCH ATTACHED N0. <br /> �� <br /> �iiut a ,,;,:'�' 3.�f�tik <br />