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� <br /> CHART N "'' ���- <br /> everett - ' <br /> /`��J � �= �� <br /> e :�_ ��1 _ z �� _ <br /> � City of Everett ' <br /> � Engineering & Community Services /�(�/J �?S ��� � r � <br /> � Sewrer Applicatio�n and Permit <br /> � <br /> � NO. � � ! L i DATE ,�t7x �, / � 7� �_ ,) /J <br /> a�����_� :��� <br /> Service Ad�ress �>'� �� ''"-� -�-�•->� �^'� Utility Account No. <br /> Billing Address `�">>ti--�'�� Permit Fee ' _ <br /> y,, p_, � � �il" �.J--O� Connection Chargc(s) �� f <br /> Cit State, Zi =-'- � � ' - <br /> �y� i <br /> Owner (Mortgagorl—", •" J�� ' v f , f'��-„(i.'Total Fee `7 v J ��J <br /> � Billing Name <br /> / / r <br /> Connection By �:zI� O�I,�j!" ',_1/ ��ri.-c. � j J+ � / <br /> .^ i r / s ��'1'vL/161� -�i`� <br /> Address - �v� --Y'��-�%-�l� Signed � =��7•C-!� <br /> � Customer ' <br /> Phone --�r> r�- ���� 3 <br /> DESCRIPTION: Sewer District <br /> Lot ��a 3 $� Block �� �a • <br /> � Plat , s` -.e�- ' ,..,( ' . ��a...t •:� c=.•_t�� Monthly Sewer Service <br /> Unpla ed Description � Monthly Sewer Constr. <br /> � -- Trunk <br /> I TYPe Pc•mit: - <br /> Lateral <br /> Remarks: /�,2k' ,,_ti.r/ ��'f-, '.. .� �S� U <br /> v Abuiting Lot Line <br /> Y �f C�� 17 N, 5, E, W ft. <br /> �.� � <br /> ( � � . <br /> � APProved By � 1._2..,�-':(-,. �.z- ., �� ,_ <br /> � Ciry,Engineer �y <br /> `` Issued By�.r._, :�,r '�� _�Y�i�lr_c.- <br /> 1 v <br /> I <br /> � Inspection By Q ! ��L�� <br /> � _ _ Date Inspected���0 <br /> ' � <br /> ' SEE SKETCH ATTACHED N0. <br /> ` Ihi`:Pf_Cl f" <br /> I <br />