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CHART...A-V-2�1�7!-5' <br />Eeverett <br />el <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 2?�70 DATE <br />Utility Account <br />Service Address <br />Permit Fee <br />Billing Address- <br />42 J�' Connection Charge(s)--7,,���� <br />city, State, Zip <br />Total Fee — <br />Owner (Mortgagor) — <br />Billing Name_______: <br />Connection <br />S gned <br />Sewer District--�� <br />-7— <br />DESCRIPTION: <br />Lot Block- Montilly Sewer Servie__ <br />Plat Monthly Sewer Constr. <br />Unplatted Description — <br />Type Permit <br />Remarks: <br />A <br />SEE SKETCH ATTACHED INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By-61 <br />issued <br />Inspection <br />Date Inspectec1z0--/4-2?---- <br />No. 22370 <br />