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everett <br />� <br />City of Everett <br />Sewer Application and Permit <br />CHART NO. <br />�e.;� � C�tc,fi,.;�( �—/3-S% <br />NO. ��7�9 DATE _�.+ �i.. 11, Ioaa � <br />Se�vice Address Utility Account No. <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) , <br />Billing Name -�'' <br />Connection By F `1 ' �,' <br />Addreu '� � <br />Phonc_ <br />DESCRIPTION: <br />Lot_ � � Block <br />Plat i . i '��":_� ; ,�;,- , <br />Unplatted Description_ <br />Type Permir. <br />Re;narks: <br />IMPORTANTI <br />CALL 1500�24-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL2593811FORINSPECTION <br />SEE SKETCH ATTACHED <br />Permit <br />Connection Charge(s) <br />Total Fee <br />tlt! Lity DahlopMn! l�u Ord. 1171-85 <br />vat�r 22�.00 <br />; <br />Signed <br />c��:m�� <br />Sewer District r+.�.� yi <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />U?J131�t3 3:t3PM OOOANli72 txtf <br />� Trunk ! _ <br />ii�lOtY.'O�B7 <br />Lateral L�-Cm R769.OD <br />PLE:G 585.00 <br />Abutting Lot Line�CH 372.G0 <br />N S E W�'LH CH l25.Or. h. <br />a. <br />G 5i.tili 4�15.OP <br />C S:,L'N §�'O.OU <br />E .dZGil V -'.:u.W <br />C�F':�N .2Q.lY} <br />Approved By <br />�NaT �F: � ib0.U0 <br />Issued By iilkAl.:o'�59 <br />ti�i—s �2.a.uo <br />t71ECti a13U3. i� <br />Inspection By�� - _ <br />Date Inspected /�- J`�-F� <br />IhSPCC?'ION <br />No. 26759 <br />