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everett <br />G RUw�.t `�i sT. <br />� c o�.. i� � r--� E/(�,{ }r <br />�� <br />City of Everett <br />� <br />( <br />9 f � �� � ;. <br />Sewer Application and Permit <br />No. 23361 <br />Service Address= <br />Billing Address_, <br />City, State, Zip � <br />Owner (Mortgagor) <br />Billing Name_ <br />Connectian By._. <br />DESCRIPTION: <br />Lot B <br />Plat � <br />Unplatted Description_ <br />. i _ <br />DATE �//���'1 <br />CHART N0. L � `�' ' `' " `� <br />�ST�D ���-8c� <br />� <br />� ' <br />Utility Account No. <br />O� <br />Permit Fee v�� <br />�� D Connection Charge�s) <br />f �] f� � <br />� d./� Fee �� <br />=—�— / � , � . - <br />� � Signedf i —�--�� 4'if� <br />_ _ / � Cusmmnr <br />T� �.%�� <br />SEE SKETCH ATTACHED <br />INSPECTlON <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By y <br />Ciry Engineer <br />1 ssu ed <br />Inspection <br />Datelnspe <br />N�. 23361 <br />