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' CHART NO._._ <br /> everen <br /> � <br /> City of Everett <br /> •� � <br /> Sewer Application and Permit � <br /> N0. 256SO DATE __�lS�_ — <br /> , <br /> Sen�ice Address �25 _ ��E��_� Utility Account No. <br /> Billing Address Permit Fee �8 � <br /> City,State, Zip_�,��„������.,�_ Connection Charge�s) 330.9� <br /> Owner (Mortgagor) Total Fee �..... <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> cu:tomer <br /> Phone <br /> DESCRIPTION: Sewer District ��I.i�_ <br /> Lot�._ Block <br /> Plat ����� �9� ��� Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: Trunk_ _�_ <br /> Lateral _ <br /> Remarks: <br /> .4butting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> CiryEngineerA� �� <br /> IMPORTANT! <br /> Issued By <br /> CALL1-800-424•555548•HOURS , ann�n <br /> PRIOR TO DIGGING <br /> CALL t59�8811 FOR INSPECTION L <br /> Inspection By <br /> _ Date Inspected �� <br /> SEE SKETCH ATTACHED N0. 2�6SO <br /> I��SPGCTIOP! <br />