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CHART NO. <br /> eYf7�CtY ' - • <br /> n 1 �� ,-„ � � �� <br /> �--' � � � �/� � <br /> � <br /> City of Everett <br /> Sewer Application and Permit <br /> No. 26657 DATE �Y� 194� <br /> Service Address . Utility Account No. <br /> Billing Address Permit Fee 30.00 <br /> City, State, Zip Connection Chargels) '+'+n_nn _ <br /> , <br /> Owner (Mortgagor) ..�y�} .g-�— Total Fee 30.00 <br /> Billing Name 5peciel Utility Fae �3. 1171-R5 <br /> aeuer <71.00 <br /> Connection By <br /> Address �� Signed <br /> Cusromcr <br /> ! Phone � <br /> DESCRIPTION: Sewer District rond t_Tr <br /> Lot Block Monthly Se�,ver Service <br /> Plat <br /> Unplatted Description Monthly Seever Co�str. <br /> Trunk '+ap o0 <br /> Type Permic: <br /> Lateral <br /> Remarks: I�S OSi:ti �u.�lu4'� i�u+l';f4il.i�,,, iC�4. <br /> Abutting Lot Line / <br /> N S E W,. ,.,. ,�-, ft. <br /> . ,:l:Wf:F' Y?ii.C�� <br /> 1'�8}1 LI :::.;i'�.tti� <br /> t i';i '_� ,71.�?� <br /> �.fAi�i; .1:?Ll��� <br /> Approved By Atc rn u +�*�r <br /> Ciiy Engineer <br /> IMPOHTANT! Issued By �usy N�9^^ <br /> CALL 1-600-024-5555 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 259�8811 FOfl INSPECTION � <br /> Inspection By ' <br /> Datelnspected 'Z_ <br /> SEE SKETCH ATTACHED ND• 26�a7 <br /> Ii���rec�ior: i <br />