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CHART NO.�_"--Y'�`���``���' <br /> everett ,� <br /> ,E /j- -��- � � <br /> e �s� <br /> City of Eve•eit �� �"' ' /� <br /> Engineering & Community Services <br /> Sewer Application Qnd PermR� <br /> DATE � ��� � � <br /> rvo. 2?_ 5r ? i- � : <br /> � <br /> Service Address �" ��` :� Utility Account No._ ' " � � ' % ���'- "' <br /> Billing Address --• � � ��%.� _ Permit Fee � <br /> City, State, Zip ! �'�% �� 'i.= Connection Charge(s) 7 � � . _ <br /> Owner (Mortgagor) �' = �' _ • '• i � Total Fee J�� � <br /> Billing Namc - "'� <br /> I <br /> Connection By � ��'r � � <br /> i% <br /> � �L�� � � , <br /> Address Si ned-=' � a 'i� �' ` �-� <br /> Customer <br /> Phone f�f// ;���fi _ <br /> DESCRIPTION: Sewer District �"' � ��- <br /> Lot � 61ock <br /> Plai_ - f' /� :, -E =' Monthly Sewer Service .-� S U <br /> UnNlatted Description_ Monthly Sewer Constr. <br /> - Trunk .- ,; ' � �. c,,> <br /> Type Permit: _ .- ,' . . � <br /> — � i :- ��q <br /> Lateral - �31 � �` ' <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W tt. <br /> � I <br /> Approved By. I <br /> Ciry Enginecr <br /> �' <br /> ISSl1CCJ BY — ' � <br /> Inspection By��cGa���� <br /> a <br /> Date Inspected�,�-7� <br /> SEESKETCH ATTACHED N0. <br /> il�;jf-'Li;il�i��: <br />