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� .G <br /> � ' ' �y. � � CHART N0. <br /> n ,, � <br /> everett �'''� ;� <br /> �. V�' � , _ �- 7 -sg s <br /> � � ._ � �o Tef'� <br /> t ,i 5 <br /> E City Of Everett . w — � � <br /> Engineering & Community Services (�� � � <br /> Sewer Application and Permit �`3 ,,g ;< <, <br /> � „- <br /> N0. � i� �� / � DATE ��� ^ �/�� ' <br /> Service Address �-� ' -" `� �' ' �--`' ,'"`'� Utility Account No. .f---�'`�- > ���F` U/ <br /> � / <br /> o� <br /> Billing Address �'�� l�-�� ' " ' � -`{' ''•/ Permit Fee 3U <br /> ,. , i � / /� %r� <br /> City, State, Zipii2.—�� ��l' • ���^'�% Connection Charge(sS J / � <br /> O �% <br /> Owner (Mortgagor) � �� - Total Fee_� <br /> �`" , % <br /> Billing f�lame ��; _;� �-'•� '- <br /> } A. <br /> �� . /�.�:.,_ . <br /> Connection By '"� � ^ - - fn'" - i':!•' � , <br /> .'--1 <br /> / , t, .%/,,.,'—,�-.=. <br /> Address Signed ' <br /> cu:tome� <br /> Phone --7'-3 y- -` �3C� — ' <br /> DESCRIPTION: Sewer District � � -y' r � <br /> Lot �� - �� Block ' <br /> � �� Monthly Sewer Service r'^�p <br /> Plat��-= � � I� : <br /> Unplatted Description � ✓ Monthly Sewer Constr. <br /> Trunk "�'yU <br /> Type Permit: � '� , /. . '.,.. /� <br /> I Lateral 7• �� <br /> � Remarks: <br /> Abutting Lot Line <br /> I <br /> N, S�W �E� ft. <br /> APProved By l�• /L�•=i i...� c<_,,._ <br /> � Ciry Enginccr , , <br /> "1 / , 1 <br /> � �ss�ed av �" _ ,� : <br /> {/ <br /> I <br /> Inspection By�d� ��`'`-� <br /> Date Inspected_��i�7� <br /> e <br /> SEESKETCH ATTACHED N0. <br /> ' .u,o.� � �'��, _ ;FI ';?�l'i', <br />