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! everett CHART N0. _ <br /> � — <br /> � _ `s � �— <br /> e k � s <br /> ICity of Evere;t _I <br /> I Engineering & Community Services �/G �� � C <br /> � Sewer Applicatiorr and Permit � � �� <br /> I , <br /> , - � i,� q��?� 7 <br /> S <br /> NO. ;'� ;' `�' ,' J DATE <br /> . . <br /> Service Address ���� � ` - <br /> �' � � i- "' Utility Account No. <br /> Eilling Address Permit Fee <br /> City, State, Zip _ Connection Charge�s) <br /> Owner (Mortgagor) Total Fee <br /> fBilling Name <br /> � Connection By__I � _ ��/�/�'� <br /> � Address � <br /> I Signed �' __._ <br /> x <br /> j Phone Customer <br /> i <br /> � DESCRIPTION: Sewer District <br /> ' Lot Block <br /> fPlat _ Monthly Sewer Service <br /> � Unplatted Description Monthly Sewer �onstr. <br /> � Type Permit: — Trunk <br /> I — <br /> � Lateral <br /> Remarks: <br /> I �O ,� i �� Abutting Lot Line <br /> -a1�, Yn � N, S, E, W <br /> f <br /> -� 5 �t ft. <br /> I 4 � /.�e-� a�- — <br /> � <br /> � Approved By _ <br /> � Cily Engmeer <br /> I <br /> � _ iss�ed e� � <br /> � <br /> � � � <br /> i Inspection 8y � �` �-�' _ "�,+i , �,..f <br /> 1 p Datelnspected__.% '" '�% - y`�' <br /> � SEESKETCH ATTACHED <br /> � NO. <br /> � IiVSI'�CTION i <br /> r .. �t vn . . . . M . <br />