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" �r1- <br /> �-- V <br /> I CHART N0. �/�� / <br /> ' evereri j�j '- %' ='�/ i � <br /> � _ ..: � ` <br /> i' <br /> t�UG �`� <br /> City of Everett <br /> � ut�uly �'.-` <br /> i Engineering & Communiry Services <br /> ' Sewer Application and Permit <br /> ; � i � L� <br /> I NO. r i `i � :'i DATE _�� / Y <br /> i � � <br /> ` . / <br /> Service Address � � ' � � ' 'r " UNlity Account No. <br /> '! - PermitFee .'�`'_v <br /> Billing Address " ' <br /> � �, I_ . <br /> � City, State, Zip ��_ `/� � Connection Charge(s) <br /> � Owner IMortgagor) -�-"'f Total Fee �--"" <br /> � <br /> � . <br /> � Billing Name <br /> F . y <br /> Connection By t--�' '{ r. ;': ��^ <br /> � � � Signed <br /> ' (�ddf055 Customcr <br /> � <br /> ' <br /> Phone <br /> Sewer District <br /> DESCRIPTION: <br /> Lot k� v Block Monthly Sewer Service -- <br /> � Plat ��----" Monthly Sewer Constr. <br /> �i <br /> � Unplatted Descriptio�i <br /> � Trunk <br /> j - "r . <br /> � Type Permit: /;.'._� ,.� r_ !� : <br /> � Lateral <br /> '� Remarks: Abutting Lot Line <br /> I � cZ` N S E W it. <br /> � C .. <br /> ` � � <br /> ' ' J, <br /> � s � 4 �- <br /> i � � v <br /> I - <br /> � Approved BY - ' '� <br /> � . CitV En9�neur <br /> I _�� <br /> � �SSUC(jBYl� ____l.—_ <br /> i <br /> � <br /> � ��' ; _ <br /> Inspection By �O ��"r`�"� — <br /> Date I nspected � �� — 7 7 <br /> a - — �,. � , <br /> N0. �r' � <br /> SEE SKETCH ATTACHED <br /> �� �.PLC1 �i -, � <br /> P�- ,y y� t <br /> . . ".4 V��-�'T'',�.. AS�.�'..iq�l� _ . S..-W..3:... e�:.; .___ . i?- . <br />