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1 <br /> CHART N0. N � ��2�1 �� <br />' everen <br /> e ,' ,,z ,��� g-2�-�/ <br /> ,,�... <br /> City of Everett <br /> �. �l+i � <br /> Sewer Application and Permit ; '; : , ; � � ;;, ,,: '�;; <br /> N0. 24051 DATE �/�/�/ <br /> Service Address Utility Account No. <br /> Billing Address � � Permit Fee �� <br /> City,State, Zip �(']/ ���� Connection Charge(s) <br /> —�---� / �' <br /> Owner (Mortgagor) ' � Total Fee / � <br /> Billing Name <br /> Connection By � � <br /> Signed . ' � t� <br /> AC�df855 Customer <br /> Phone <br /> � DES IPTION: Sewei District <br /> � —�� BI r � Monthly Sewer Service <br /> lat "' <br /> Unplatted Description Monthly Sewer Constr. <br /> � Trunh <br /> Type Permit: - <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> tJ, S, E, W ft. <br /> . ^ <br /> � 6:4���!`� <br /> � Approved By <br /> I CnV npineer <br /> + lssued By ��� <br /> Inspec[ion By �� � <br /> Date I nspected�� `-� � <br /> SEE SKETCH ATTACHED N�• Z4OS1 I <br /> IhSPECTION � <br />