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everett <br />e <br />City of [verett <br />Sewer Applic�tian and Permit <br />January 3, 19Y0 <br />rvo. 23443 <br />DATE <br />16 Hcut Ptarilyn <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By City of Everott <br />DESCRIPTION: <br />Lot Block <br />Plat S•p• '-202-13-79, Lot 8 <br />Unplatted Description <br />�r..__ n...._:�• t7PW rnnnection <br />CHART N0. y �� L�' y <br />i <br />Utility Account No. <br />Permit Fee <br />nonc <br />Connection Chargel <br />none <br />Total Fee <br />Don t�tiller <br />Signed <br />Sewer District <br />Monthly Sewer Service. <br />Monihly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />SEE SKETCH ATTACHED <br />INSPECTION <br />F2. Warzen <br />Approved By <br />City Enginccr <br />r. sona <br />Issued By <br />Inspection By � /� %`Ji�.C'<'/fif� <br />Date I nspected �� � '� � <br />No. 23443 <br />