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everett (' <br />r ' <br />City of Everett 3 <br />Sewer Application and Permit <br />No. 22871 <br />Servir e <br />Billing <br />City, St <br />DATE <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address�� <br />Phone <br />DESCRIPTION: <br />Lot-2 lock 3 <br />Plat �DF/�� ,/f%- C-� <br />Unplatted Description_ <br />Type Permit: j1___�— /' _ %7 <br />Remarks: <br />CHART NO. E3Z Z 9-5' <br />lity Account No. <br />mit Fee__ <br />inection <br />Total <br />Charges) <br />e <br />Signed <br />customer <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk— <br />Lateral — <br />Abutting Lot Line <br />N, S, E, W_ <br />Approz ` <br />City Engineer <br />Issued 8y <br />Inspection B --f' =� <br />—� _ �Q <br />Date Inspected G <br />SEE SKETCH ATTACHED NO. 22871 <br />