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CHART N0. ^�g—��S <br /> everett � : <br /> I ��S�`—�� <br /> e � �� <br /> � _ � <br /> City of Evereit /I��� <br /> Engineering & Cmamunity Services <br /> Sewer Ap�lication and Permit <br /> .� <br /> NO. �� f ; Fj DATE `���' �! '7 <br /> � <br /> Service Address__� - f / ��0 �� � �-� _ /.Utility Account No. <br /> B�Iling Addre;s Permit Fee —' <br /> � Ciry, State, Zip ' iE".: % -" • �� '� Connection Charge�s) <br /> _.�--� <br /> . <br /> Owner (Murtgagor�_ Total Fee — <br /> 8illing �!ame <br /> Connection By � ' _�— _ <br /> Address ���% _,__ Eigned / (, <br /> Cusio�ner <br /> Ph�ne _ _. _ <br /> DESCR:°TION: Sewer Distric*. <br /> Lot Block <br /> Plat _ Monthly Sewer Service <br /> Unplatted Description _Monthly Sevaer Constr. I <br /> Type Permit:�� % % . " . Trunk <br /> �_ . _ _ <br /> Lateral <br /> Remarks: �� ��� � � �� Abutting Lot Line I <br /> ;:Zic�c �a.:.«_�e_.�.�i�><rti�, /,, ' c .'- N, S. E, W_ ft. <br /> i <br /> �L��Ccc ,�� '- /�-d' ' ". � I <br /> �r-� s4 S�� . I <br /> Approved By_ '-' _ I <br /> YCiiy Engineer <br /> � � � <br /> -- Issued By - - �� I <br /> � I <br /> � Inspectior By `' �-c� ��- .•� yr- _<_ JT <br /> Datelnspected_ '% - / ' = j �'� <br /> a <br /> SEE SI<ETCH ATTACHED NC. ' � <br /> I� i;;P�i;il0id I <br />