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' I CHART N0. �- ' ' `^`t . ` <br /> ; � --�� ...' (y_; . <br /> i <br /> everett '" -, ` ' <br /> I � <br /> � City of Everett <br /> ' Engi^eering & Comm����it� Services <br /> 1� Sewer �pp�ication and Permit <br /> � <br /> � NO. 1 ' 1 i� r_ DATE �-�' � ' �L-- <br /> j �'(� � '; _.�_- ;, r� +_�e . ���.. UtilityAccountNo. - =• •= ;''- �' l' <br /> i Service Address JL- � _ <br /> �' Billing Address � r�I O�T ,-'G�,`� �r �� � Permit Fee <br /> J L� <br /> � � � � t, C v �i�� .:_,�lc,I`�7 <br /> � City,State, 2ip �— � ` � �-��"T � � Z CiQ� Connection Charge(s)- — <br /> ` � , cs-, <br /> � Owner (Vlortgagor) `'�� ��`"�'-� `}C�'� �' `` �}� � �� ' Total Fee_ <br /> � <br /> ` BillingNarne ' ��� ���C- <br /> I ConnectionBy �'��''�= l <br /> � _ Signed (� lr 1 'i..,'; 1� <br /> Address �—''��''•'lC' ; cusromer <br /> I � <br /> I ,�` � : t �:—�{— -- <br /> Phone — J <br /> fSewerDistrict=' �` +—'�-`�.1J �- — <br /> { DE$CRIPTION: G , "U <br /> � Lot Bleck Monthly Sewer Service <br /> � <br /> � Piat � <br /> Unplatted Description��'�— �" �t':��4 L : Monthly Sewer Constr. <br /> � ` <br />, Suern.-r �7t ry-- Trunk 'G• �� _ <br />� Type Permit: �J��U C� aN�"—' <br /> k Lateral Z ? � <br /> 4' Remarks: Abutting Lot Line <br />� i N S E W__ — ft. <br /> I <br /> fl Approved By � • ���-���'�-' y <br /> CiIY Enpineer <br /> IIssued By � � ,_1 LC,Q �:i ti�� <br /> t <br /> Inspectian By ''�" ^'" "'`�'�---- <br /> I /�, �7 -7 <br /> Date Inspected �T— <br /> 1 0 -- —— NO <br /> SEE SKETCH ATTACH F <br /> �--r- -i--ic�.-'ri Q"'`��,txr� S\: <br /> I —�^ r' c�'.i � - - ? �• . <br /> � � .-- .. .._. . ._._ . � . _ .. _ ..�. ' r'. � . . .i � �..�k�i.cr <br /> � <br /> I <br /> � <br />