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ki <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 22U'')4 DATE d—A- // <br />Service Address )n ,, > �/ � " <br />Billing Address <br />Citv, State, Zip <br />CHART NO. Xzo �2 • <br />IPa S <br />Utility Account No. <br />Permit Fee <br />Connection C <br />Owner (Mortgagor)/' ! %v' T_ Total Fee /J <br />Billing Name <br />t <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot—/ <br />Plat <br />Unplatted Descriptio <br />T.•..0 D-it. <br />Block, Y/ Y <br />k, <br />SEE SKETCH ATTACHED <br />Signed <br />Customer <br />Sewer District__ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />butting Lot Line <br />N, S, E, W_ <br />pproved By-_ <br />City Engineer <br />sued By , � _ <br />i <br />Ispection By Cc .� .+' ^ <br />ate Inspected <br />NO. <br />