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1 <br /> CHART NO. T � �-Z� �S� <br /> Ieverett � � <br /> I � �'�5�� <br /> � ,�2� —�S <br /> I City of Everett � � <br /> �� <br /> � S�wer Applicction and Permit <br /> N0. LZ�50 DATc �_ .'' <br /> . �7.,,, � �� ' Utility Account No. <br /> Service Address �'�3�-� «-�`� � � <br /> Billing Address�<�-:���� Permit Fee� ��/ <br /> ` +_ r_. <br /> �• � Connection Chargels) y <br /> City, State, Zip��-'�-;���'���� nt�f� I <br /> Owner (Nortgagor) '�� �� �%�'-�` � % � Total Fee <br /> �� <br /> Billiny Name <br /> i <br /> „> .� �>_ �!� '.� � �� � c <br /> Connection By ._ <br /> . <br /> ,�_ i / Siyned !��_,�,�t.�,� �'7G�� <br /> Address� _ Cus�omcr <br /> Phone_ ,?��=,y l� <br /> DESCRIPTION: Sewer District <br /> L �`// I <br /> Lot.��al�- �_- L�loc,�k���^''. Monthly Sewer Service �— <br /> Plat �t�sd�_—.-�ti-:�.��-l— <br /> Unplatted Descripiion_ _ Monthly Sewer Constr. <br /> _ __ _— Trunk <br /> Type Permit: _ <br /> i --- Lateral <br /> Remarks: ,e��ltNqg.�l.ot Line --� � ,� � <br /> _ S, E, W ���� ft. � <br /> ��r;�H{� � I <br /> E�y r � <br /> ��ved By I <br /> ,� Ciry Enginecr <br /> — Issued By - � <br /> . - � � <br /> fnspection By— ` -"' � <br /> Date In:pected�"� `� _� <br /> �� " ETCH ATTACHED �o. 22858 I <br /> „_E �K <br /> INSPECTION <br /> �. <br />