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CHART NO`3 / �?"� �� � <br /> everett .r �� �� � � � , <br /> e � <br /> .�e ST�:� � <br /> City of Everett C� ?. R � ? D <br /> Engineering & Community Services <br /> Sewer Application and Permit /�� � <br /> /r � - <br /> rvo. 223 � 3 DATE !�t i� � ,, <br /> �� �Service Address ' ' '=� ''' '`- " �" %J Utility Account No. <br /> Billing Address Permit Fee I <br /> i <br /> City, State, Zip. - Connection Charge(s) j <br /> /� ' , ,_ , .,._ I � _ i <br /> Owner (Mortgagor� ' � Total Fee i <br /> Billing Name - ' �� ����- � � <br /> Connection By_ `�--' �`t `"'� C"'L �'` �� ' <br /> � <br /> ': , . � <br /> Address Signed_ �- � i-�J`%+��� - �= <br /> � <br /> Custumcr <br /> Phone_ 1 <br /> DESCRIPTION: Sewer District. i <br /> _, <br /> Lot ' ` Block ! <br /> ` ,� •` t_ L � i : ti+ 4 Monthly Sewer Service — <br /> Plat i. ,- <br /> Unplatted Description_ Monthly Sewer Constr. <br /> — Trunk <br /> Type Permit: h.�t ,e.� L,r..it-=�= i`. <br /> — Lateral <br /> Remarks: .,�s�q�',aC�e��-cr.�s�' / ��_ '" � <br /> Abutting Lot Line <br /> f, .n� �a<�.... 7 �C�CC �Ct ��. N, S, E, W ft. <br /> ,_ �.w �s.tc�-e__ '��c c L, i <br /> — ,; i <br /> Approved Qy �- / .'c_, �.�.��i: -�. [� I <br /> Ciry Engineer <br /> � <br /> / . <br /> Issued By ' "-` : i ; ; ' � <br /> 1 <br /> i <br /> — . � � � <br /> Inspection By <br /> � <br /> Date Inspected � —� — /� � j <br /> p I <br /> � <br /> SEE SKETCH ATTACHED N0. •. ' <br /> IN4(��r�-i-Inp � � <br /> ��.� V� '. ..�, . �� �`�'� &�1 ccr�aw- 1 <br /> � ���i'r, F;�� � _ . �,r. _. . .. . .. <br />