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of <br />W <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22616 DATE 'J�-J/-71 <br />CHART NO —30—Z�,' S <br />� 1 <br />Service Address Utility Account No. <br />Billing Address ;' r x 'y 7 _ Permit Fee <br />City, State, Zip—' '.-• -� �Lr �. i j ''l Connection Charges) <br />Owner (Mortgagor))/ Total Fee <br />Billing Name -- <br />Connection By Address ----Signed / 7- y/ F-VfVt'-r <br />Customer <br />Phone_ <br />DESCRIPTION: <br />Lot Block - <br />Plat <br />Unplatted Description <br />Type Permit: <br />a <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By, = 9+ .' -7 � ,. <br />City Engineer <br />Issued By— ✓ -s' <br />I nspe( <br />Date I <br />No. 22616 <br />