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everett CHART N0. " J� - � <br /> '+ h <br /> _. �__C�S, %E/� ; ! <br /> � `: I <br /> City of Everett ���� ' �� '•' , <br /> � I <br /> Engineering & Community Servicec � <br /> I <br /> Sewer Application and Permit '. � <br /> � <br /> NO. � ` � �� ;J DATE �- �i- i% � <br /> Service Address ���� � d�/' : - �-' . Utility Account No._�� -:• 7- U 7.: -/J U � <br /> .l l.,' °-=^_ I <br /> Billing Addressl y�d •%<«��-��---- •--�- Permit Fee J � i <br /> City, State, Zip:�-�!- =- i /� ,•-✓�� . �/y ' O ,J' Connection Charge�s) SSU '' <br /> ,�r / -i / c% I <br /> Owner IMortgagorL�-1 -� J Total Fee__j4 i <br /> Billing Name _ ��,, � <br /> Connection By ---;;.�- �-.- � <br /> P.ddress Signed � , `I ��/ . i�."<iy!r:y`_ <br /> Custo ner <br /> Phone__ — ✓ 5�- '> ; ::'U <br /> � <br /> DESCRIPTION: ' %' -" I <br /> �. Sewer District �� % . ���, ( ,IL � <br /> Lot ... � Block � <br /> Plat— �/�.- - ��� MonthlySewerService a • �V <br /> � � <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: ��f�, ,- • 1� Trunk / • / S' <br /> ,-, �. '.,. <br /> Lateral (-" • .;' S <br /> Remarks: <br /> Abutting Lot Line � <br /> -- N, S, E, W ft. <br /> ,.a�!/ (i <br /> �- �- ���/. . <br /> ✓J? Approved$y�_•'�F-�'-� . <br /> . � Cily Enpineer <br /> Issued By �" - '�-�. . � _ <br /> _ <br /> _ Inspection By_ / � <br /> �J I <br /> 1 — Date Inspected /� 3� ��ir � <br /> i <br /> SEESKETCH ATTACHED NO. � j <br /> INSPLCTION - j <br /> • � . . . _ . .__ . . . _. . . ... . . 1 <br /> r4 <br /> �,. <br />