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1 <br /> everett CHART N0. /�_/2_�g l <br /> i <br /> � <br /> /�a S /' ,L-� I <br /> v <br /> City of Everett �� — .3� - � �' <br /> Engineering & Community Services ��j <br /> Sewer Appfication and Perrnit <br /> � <br /> N0. _ ;) DATE ( J .I �..� C' <br /> t <br /> �� <br /> • a c .� - <br /> Service Address � � -'U T � l-=� �c= ;� <br /> Utility Account No. �` ��L'� �1 q - �� <br /> BillingAddressP'�• �j`� t- �� '._ C� , <br /> _ Permit Fee '"..�C�' — + <br /> Ciry, State, Zip � �/� r_7'T � � <br /> / � � Zv �� Connection Charge(s) l�'�� �• L-.�: � <br /> Owner (Mortgagor) l..-� ! ,�.� ��:V- GX.:, � l--��, �� C��' I <br /> t Total Fee ��� � --- � <br /> Billing Name�-k_,!�..� C'J k�� � U ----- <br /> C <br /> � - i <br /> Connection By L !�- � � ' � <br /> r�w: c._. 1�c_ <br /> Address �• v. �.�`f L.1-1 c -- '� t� n � <br /> � Signed ...� X..-`... l "/ �,�^ � <br /> Phone �� J-� � -�� ��.. 1 C sWmcr � <br /> i <br /> DESCRIPTION: � <br /> Lot �__ B�a�k Sewer District L" E".� G +.� �� _ <br /> Plat TC::.• _L^ti, , � L i) • .L� <br /> Z ` �-„��e nr_,�, ( ,� Monthly Sewer Service �--' �'" � <br /> Unplatted Description <br /> (`�-� � L _ + -`bZ _ , � _ � Monthly Sewer Constr. <br /> �.� <br /> Type Permit: �1�`�� Trunk �� �L C� <br /> �.c n.i.���i� c:,u <br /> Remarks: Lateral 'L, ��i + <br /> � <br /> Abutting Lo[ Line � <br /> i <br /> N' S' E' W--- � <br /> ' ft. � <br /> / � <br /> — /aPProved By L . �I L..l.� �.:i � ���.1 <br /> Ciry Enginccr <br /> Issued By����_�, nr 1�:1r.i <br /> � � <br /> Inspectian By�C�i�� �er^ <br /> Date Inspected �/$���' + <br /> +I <br /> SEE SKETCH ATTACHED i <br /> I� I��;;:i"ril:7': � NO. � <br /> - ! <br /> � <br /> � . <br />