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1 , � �� <br /> 'J - C� ' CHART N0. � '- <br /> ever�tt ' <br /> � , �: . n��-, !. .7 J���/ <br /> 1" <br /> ' �/� /. _ <br /> City of Everett ` �/ ; <br /> Engineering & Community Services <br /> Sewer Application and Permit <br /> NO. ,., :, � ; . :� DATE / % J j <br /> _ _ . ;���s <br /> Service Address � ` ;�` ' Utility Account No. <br /> Billing Address ' % < '��� f�' .' , �" Permit Fee �� <br /> , <br /> City, State, Zip � f, ' - % ' �'� � Connection Charge(s) <br /> Owner (Mortgagor) ^_� Total Fee_ -- <br /> Billing Name ' .--- <br /> Connection By <br /> Address Signed - � <br /> .- Customer <br /> Phone — <br /> DESCRIPTION: Sewer District .'� <br /> Lot Block � Monthly Sewer Service ' <br /> Plat ' ' <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> . Lateral <br /> Remarks: <br /> Abuttiny Lot Line <br /> N, S, E, W _— it. � <br /> :��� �_'�y'i�� .-� I <br /> � <br /> _ , <br /> � Approv + By ' ' <br /> Ciry Engincer ��- '� <br /> � <br /> �� � � Issued By <br /> � 'Lt���.n <br /> Inspection By ���'��� <br /> � � <br /> L �J <br /> �Date I nspected � -M__ � .� <br /> 3 <br /> SEE SKETCH ATTACHED "��� <br /> .. , . r�.,. <br /> ., u xA�Y..iatiA .�-�a.vr+�w,a���a<a�.,,#, �..:>�`��. <br /> .cf5"di'x , f� <br />