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everett <br />e <br />City of �verett <br />Sewer Application and Permit <br />CHART <br />.�f�,;T T' Ci/A�Ti,t(% /�/ /j'7 <br />N0. Z631T DATE �t 2S 1l67� I_ <br />� <br />Service Address 2� ��_ ���`'�� Utility Account No. <br />Billing <br />City, State, <br />[� <br />�tl. 101 l�O3� <br />Owner (Mortgagor) � � <br />Billing Name s� <br />Connection By ��� � �� <br />Address t{t� i7tL �i�. N�t�i13� <br />Permit Fee �•� <br />Connection Chargel <br />Total Fee 10.00 <br />Signed <br />custome. <br />PIIO�I@ �$}�� <br />OESCRIPTION: Sewer District <br />Lot B��k Monthly Sewer Service <br />Plat <br />U�platted Description Monthly Sewer Constr. <br />Permit: <br />Ramarks: <br />IMPORTANT! <br />CALL 1-6004245555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 269R811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By �� �' �' <br />c�a e�w��ex <br />Issued By �� ��n <br />1� <br />/ i� 'i, � <br />. � . . _e!!. : �Wi �:� <br />,�,� ,��, „-� . <br />�. � . .�. .�i .ii/� � <br />,� . <br />INSPECTION <br />