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i � <br /> CHART NO. <br /> � everett i <br /> � � �OS��-D I <br /> B- ll - ga. <br /> City of Everett n 5�.1, <br /> Vd' � <br /> � <br /> i Sewe�:� Ap�licatson and Perr�it ��i <br /> �4259 -� _ I <br /> NO. 7 DATE �'!! i �_ I <br /> i <br /> i <br /> Service Address %' ' Utili[y Accaunt No. �r � '' ' ' "' `�- � <br /> ; �� I <br /> � Bilfing Address < ' Permit Fee � <br /> I -/ % '/ -, i�' Connection Charge�s) ` � ' ^ I <br /> City, State, 2iF J � <br /> Owner (Mortgagor� Total Fee__ — ' <br /> Billing Name �i <br /> ; i <br /> ; Connection Eiy - <br /> I Address Signed � <br /> �. Cuvomer , <br /> ; Phane __ , .--- � <br /> � DESCRIPTION: Sewer District ' " <br /> I <br /> ' Lot Block ': <br /> _. Monthly Sewer Service <br /> � Plat � <br /> ; Unplatted Description Monthly Sewer Constr. <br /> I __ - Trunk , <br /> I Type Permit: <br /> I Lateral <br /> �, Remarks: Abutting Lot Line <br /> I h S E, W ft. <br /> I <br /> I _ <br /> , — <br /> I <br /> — Approved By �� <br /> ' City Engmccr . <br /> Issued By � — <br /> r_ <br /> I <br /> Inspection By��(��t`.��v�-- - <br /> i <br /> Date Inspected � � �5�-�� _-- <br /> SFE SKETCH ATTACHEU N� GAFZSa I <br /> � <br /> _ 'NS�`C�.1 �C�i�. �. <br />