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CHART NO. <br /> everett <br /> � � S��-� �� ,�sr,�� <br /> � �5.�, i <br /> City of Everett � � � � � � � � �'S <br /> � r� ae `w+ aDVCr v'ri � � <br /> ` �d .� ar .w w <br /> Sewer w4pplication � " �e� _ <br /> � � � `�� � � ` . <br /> N0. <br /> Z7$2J DATE � Jn1�10�19 � � � � c. � <br /> 2011 Oalu� AV�. <br /> Service Address �,���•�� Utility Account No. <br /> Billing Address�r–__ ..,., Permit Fee_ �.... <br /> City, State, Zip ��}}��—qg��e Connection Charge(s) <br /> 30.00 <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> � <br /> Address Signed ' � - <br /> cu:tomer <br /> Phone <br /> DESCRIPTION: Sewer District__ <br /> Lot Block <br /> Monthly Sewer Service <br /> Plat <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: p� tion <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By ICENNETg C. H00.SDEN <br /> Ciry EnBineer <br /> IMPORTANT! <br /> Issued By SUcy Ht�nasn <br /> CALL 1-800-024•5555 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 2595811 FOR INSPECTION /� <br /> Inspection By ��`� <br /> Date I nspected � –�–S� <br /> SEE SK[TCH ATTACHED NO 278`� I <br /> IUSPECTION <br /> i <br />