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e�ver tt <br />. <br />City of Everett <br />l�,�oG io-i$ - ; S <br />i/-z�-�s <br />Sewer ApPlication and Permit <br />No. 23zss <br />DATE _� � ' ' <br />CHART NO. " ' � — <br />� S%Et� <br />,3- ZS- �a <br />�� <br />Service Address 3�� 5 �"�� ��—�—��tility Account No. <br />, � <br />, Permit Fee _ — <br />Billing Addre� s <br />,� ; ' Connection Chargels) <br />City, itate, Zip <br />pwner (Mortga3or) <br />� ' Total Fee —� <br />Billing <br />Connection <br />DESCRIP�TION: <br />Lot � ` � � Block—/,,���- <br />Plat " �o �� �%�� � J <br />Unplatted Description <br />Signed c����o�� <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />abutting Lot Line . <br />N, S, E, W— <br />SEE SKETCH ATTACHED <br />INSPECTION <br />A(JpfOVBd BY ��t� Engineer <br />Issued <br />Inspection By <br />.���, � C <br />Date I nspected �� � � � 9 <br />Na� 23215 <br />