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CHP RT NO. "' �.� � � <br /> everett <br /> � �OS G'�� ' <br /> �'- 3 - � � <br /> City of Everett 1 ln� <br /> UT <br /> Engineering & Community Services �� <br /> Sewer APplication and Permit <br /> 4 <br /> N0. . � ? :> DATE � �- � �cf/. , i�� .- .� ,_�c � <br /> Service Address ���r '-� "� � Utility Account No. , <br /> Billing Address Permit Fee '�� <br /> City, State, Zip Connection Chargels) <br /> Owner (Mortgagor) Total Fee �- <br /> Billing Name_ <br /> Connection By �� ' .�: � / <br /> Address— / �� � Signed ' � '� <br /> Cusmmer <br /> Phone <br /> DESCRIPTIAN: Sewer District <br /> Lot �O Block � <br /> Plat Monthly Sewer Service ' <br /> Unplatted Descripiion Monthly Sewer Constr. <br /> i <br /> � � � ,�i,� Trunk � <br /> Type Permit: � <br /> Lateral <br /> Remarks: _�_�� � � /v. <br /> Abutting Lot Line <br /> ' l.y�' Gr-C.� - ' N� S, E, W _ft. <br /> !�'l_ � <br /> � <br /> ir.auJ � " Gox�-r� �� ;;/ _ � <br /> /�, _ �/ �(-� Approved By� '..�' ' � <br /> �'w�� /� /_• � • C��y Enginecr • <br /> �� � �� � <br /> ���3/ / � /��L i Issued By � - --'.="'�,. <br /> i <br /> i <br /> ; <br /> Inspec[ion By ' <br /> e — — Date Inspected_ `� -� � - 7 �_ <br /> SEESKETCH ATTACHED NO. <br /> , � <br /> t'' <br /> -+.. <br />