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CHART NO.— <br /> everett <br /> e <br /> City of Everett <br /> Sewer Application and Permit <br /> N0. ZJ2�2 DATE 9�y�P �' <br /> Service Address 3 � Utility Account No. <br /> � ��- <br /> Billing Address����oo � Permit Fee � <br /> City,State, Zip�r� ' o ^ ,�Q_ � Connection Charge(s) <br /> � �� <br /> Owner (iWcrtyagor) Total Fee <br /> Billing Name '`L� d ^ <br /> Connection ByT ���_`�-�' <br /> Address Signed <br /> Cusromer <br /> Phone � S q - �97� <br /> DESCRI,PTION: Sewer District <br /> Lot �7 �.-� �����`��` B k /� MonthlySewerService <br /> Plat-5,g�r'"��—a vy <br /> Unplatted Description Monthly Sewer Co�str. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By_( ,!�' � '�"" <br /> Ciry[ngineer <br /> Issued BY � ( '� <br /> Inspection w/ <br /> � �'6�/......- <br /> Date I nspected �� -�'� <br /> SEE SKETCH ATTACHED NO. G5232 <br /> INSPECTION <br />