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CHART NO. C 20 _` Gs <br />everett <br />e <br />i <br />City of Everett <br />E <br />Sewer Application and Permit <br />No. 23397 DATE <br />3927 rainier <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />City of rvertt <br />Connection By <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descripti <br />11/16/79 <br />Utility Account No. <br />Permit Fee none <br />Connection Charge(s) <br />none <br />Total Fee <br />11 2 <br />V9 <br />D= Hiller <br />Signed <br />Customer <br />Sewer District <br />Block Monthly Sewer Service <br />Monthly Sewer Constr. <br />Remarks: T 0 /14f'cJ21 <br />L t��cL / <br />4/0 <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, IN <br />X1fYXKEftB H. Warren <br />Approved By <br />City Engineer <br />E. Boni <br />Issued By - <br />Inspection By -- <br />,r ...�.e.e.r -.. <br />Date Inspected <br />NO. 23397 <br />INSPECTION <br />