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CHART NO. <br /> : everett <br /> yr� �/ - - TO POST�NG `�,� , Z <br /> �'y�a I _ - = _� <br /> G�H City of Everett : _ <br /> aym <br /> � �� � Sewer Applicatian and Permit <br /> H x . - <br /> '�tl H'i1 I . - _: <br /> y~ I -7q A ril 9 1792 <br /> � �� NU. �H f DATE �_ � <br /> O� � �I 1102 Rucker AvQ Utilit Account No. . <br /> �j Service Address Y <br /> H K1 O <br /> H" ng �� Billing Address gRme <br /> � H y II City,Slate,Zip Everett RA 9R201 Permit Fee $ 10.00 t <br /> g 'n r-, Owner Ferol Becz Connection Charge _ � <br /> c� G y f <br /> � c�� Connection by Carl Larsnn Conntruceion Trunk $ � <br /> , <br /> Hocyi� � Address 48�� 76th SW Lateral $ � <br /> � <br /> Hukilteo 4R27S Total Connection Charge $ ! <br /> �, Phone � Utility Development Fee � <br /> ' I�I Legal Description: Water $ ; <br /> Lot Sewer $ <br /> �"`� Block Total Development Fee $ <br /> '„ � I Plat � <br /> �' '! Unplatted Descriplion: Sewer Bond Dietric[ <br /> (� �) I Abutling Lot Line <br /> �`� N,S� E,W ft. <br /> f�'.�) Type o� Permil eevez niteration Approved By <br /> I Remarks hoc tub drein ncedn to bn hooked Issued By— M. Haghea <br /> f Y; I up to the acvtr _ Customer Sigc3Wre — <br /> � IMPORTANT! 1 <br /> � �� ����PG'✓,, .. <br /> ��s CALL 1-800-424-5555 48-HOUflS �".` / <br /> I PRIOR TO DIGGING —�ic�� �/� �- � <br /> Inspection By <br /> CALL 259-8010 FOR INaPECTION <br /> Dato Inspecled <br /> I, <br /> � SEE SKETCH AlTACHED N0. 28679 <br /> � <br /> j IiJc>i'GC��ICd' � <br />