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everett <br />� <br />��ty of Evcrett <br />Sewer App���ation and Permit <br />No. 23929 <br />DATE � `� <br />CHARTNO. L �2�2q"S — <br />�oSfL� 'S- 11-BI <br />�� <br />,� . � Utility Account No. <br />Service Address' ��1 ' � _ c` ` ' <br />� � ,;, ._ -- Permit Fee <br />,:i-�! -r-, . �-.+ <br />Billing Address� ' r i �� <br />� ; � , ; i '_ Connection Chargels) <br />City, <br />State, ZiP--. , -�....i. ' ��-, r r � <br />- � - Total Fee <br />Owner lMortgagorl� , ` ' `- ' (_ ` ,:_� ,;- �, j _ � � <br />� � �', _ �c:�i . ... <br />Billing Nem� - <br />,,., _ i.�. r._ � i1 <br />_,_, i.._.� - <br />Connection B��' ` � � '�. <br />�4 _ � � Si9ned Cuslomcr _../ <br />Address ' ' � ' , � .. � ' .. <br />.._ : � _. �_.. <br />.-.- - '�dr,` fL <br />Phone <br />DESCRIPTION: <br />i <br />�ot _ ��_;/ �� Block ! <br />L, � �. _. �. � <br />L ,, � i-`> <br />Plat <br />Unplatte�� Description.---�— <br />�; _ <br />Sewer District� � <br />' ! c. <br />Monthly Sewer Service " <br />Monthb/ Sewer Constr. <br />Trunk,�-= <br />Lateral_ <br />/ i. � <br />butting Lot Line <br />N, S, E, W_� <br />KETCH Al'TACHED <br />INSP[CTION <br />/✓ /.:.'" �i' i,, <br />\pproved BY � c�iv E�e�^�ef <br />� ssued <br />r <br />Inspection BY <br />Date lnspected � pRI L �— <br />No. 23929 <br />tl <br />