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1 <br /> —" J� , � CHART NO.���r'�'�/y� � <br /> everen � �� �~ ._ �� . ,� L, �', /. - % - y <br /> � �m-,���-�o ' <br /> � DEC 2G I97B • <br /> ._.. , � . <br /> .._._.............._. � <br /> CITY OF E4[R[T <br /> /� r ,��� � <br /> City of Everett PuClic 1Yorks I�e�,; /�.C" _ " <br /> Engineering & Community Services <br /> . <br /> Sewer Applicatio� and Pe�rmit <br /> NO. � � � UATE ��_ ' �� - <br /> . � G �J l4 ?��� L' fc'd. � <br /> Service Address �'�'^� —����' Utility Account No. J- [� 'j_ r ,. `, "� � <br /> � <br /> Billing Adaress � � � �` - - � �---- Permit Fee_ �U i <br /> '.� <br /> City, State, Zip �` - i=r� . '/J -"i- i Connection Cha�ge�s) ��� <br /> <.:� <br /> Owner (Mortgag�r) i _� Total Fee_ %`% <br /> Billing Name <br /> Connection By �-- % <br /> Address Signed �� �'1---��5'^''`��'��" + <br /> � C�slomer <br /> i _� � <br /> Phone .� '% _� - ;'. _ ,-: _ _ --' <br /> DESCRIPTION: ` Sewer District_> _ - r � <br /> Lat / Blo�k Monthly Sewer Service_ r" • =�U <br /> Plat -� <br /> Unplatted Description Mon[hly Sewer Constr. <br /> Trunk U ' �5� <br /> Type Permir. / - ' _ ' - �/ 1 U <br /> Lataral <br /> Remarks: � ? ,.� <br /> � ' Abuttin9 Lot Line � <br /> � f � �. Y''r � f-� p:, S, E, W ft i <br /> . ,r: � - 1 <br /> ,� � � <br /> - Approved By' - '�-° � <br /> — Cily Engineer � I <br /> > - t . i <br /> --- — Issued By - � <br /> � <br /> — I <br /> � <br /> Inspection By r'C �"d���� <br /> Date Inspected /c� ������/ <br /> 3 <br /> Si'E SKETCh ATTACHED N0. <br /> , �,;,; I <br /> .: < . � I <br /> r- <br /> �. <br />