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CHART N0. � � <br /> � everett <br /> ` � ��stc � <br /> City of Everett T /� <br /> Engineering & Community Services / /-� �� <br /> � Sewer Application and Permit 3 - 3 l - 7� <br /> � <br /> N0. � ;� I1 �. 1 DP.TE %/- �i- lL--- <br /> :. .. , / <br /> Service Address / �� ' % ' ; Utility Account No. • - � - — — <br /> . �. <br /> Billing Address 7 � U" - - Permit Fee <br /> City, State, Zip >� •'`i � ' _ -_� Connection Charge�s) � ' <br /> `i <br /> iOwner (Mortgagor�_� To[al Fee � % <br /> � Billing �ame -'' <br /> � <br /> � Connection By `--'' �� ' - <br /> Siyned i , ' l')11�c�- <br /> � AddfC55 �Cusmmer r� <br /> Phone -� '� y- , ��� <br /> DESCRIPTION: Sewer District '� J— ,l1' <br /> Lot %'� Block % <br /> Monthly Sewer Service <br /> � Piat � � � <br /> l.nplatted Description Monthly Sewer Co� �tr. <br /> / - <br /> � Trunk � "' `� <br /> - � . <br /> Type Pei.nit: - ; �� �� <br /> Lateral - <br /> i <br /> Remarks: Abutting Lot Line <br /> � N, S, E, W ft. <br /> i _ <br /> � <br /> t — <br /> I Approved By ' <br /> Ciry Engineer <br /> I <br /> � Issued By �� <br /> i <br /> ! � <br /> ! <br /> � Inspection By. —��, �'����"'' <br /> � Date Inspected �/a � � � — <br /> 0 <br /> SEE SKETCH ATTACHED N0. <br /> �� 'i�'�'PLGTIOP� <br /> , t <br /> � <br /> ��,",'^ �,�, ' - <br />