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evereli <br />e <br />City of Everett <br />CHART <br />� _ <br />�:1,- :; � m ���,-�- �, /O � �� E b, <br />� <br />c <br />.�. <br />� <br />Sewer Application and Permit � � � . .� <br />� V <br />� �� <br />N <br />N� ZSHBH DATE <br />Service Address 161� �t Driw Utility Account No.. <br />Billi�g Address <br />City, State, Zip <br />Owner (Mortgagor) ++ +� <br />Billing Name <br />Connection By <br />ada►� — <br />Permit Fee �^ � <br />Connection Chargels) <br />Total Fee �� °° <br />Signed - � � <br />cuswmer <br />Phone •,�-,lil — <br />DESCRIPTION: Sewer District <br />Lot Block Monthly Sewer Service <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�800d24-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259�8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />itY nqineer <br />Issued By .�. • � MeLeA <br />v <br />Inspection By — <br />Date 1 nspected / D�� 3— 0 <br />NO. �vv�v <br />INSPECTION <br />