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everett <br />e <br />City of Fverett <br />Engineering & Community Services <br />Sewer Application and Permit <br />CHART NO.� 9� � <br />� � _� <br />i�`"��`' G�� <br />C � �CJ <br />F, -- � o <br />/ w-''L'�C <br />N0. l,;iii;� DATE %��=' "' />> I� <br />Service Address y� J� '� �"' Utility Account No. <br />_� <br />BillingAddress `�'�/� ,:,, =`�`�+".�� PermitFee -'"� <br />/ <br />City, State, Zip -- ---� ✓�. %r�f6.i6 Connection Charge�s) <br />- � � <br />Owner (Mortgagor) T--r,� Y--�-.-- -� /�'� - r Total Fee -3 � <br />/ � <br />Billing Nemo%�� �� /�� /.�' / <br />Connection By - "- - <br />Address � %. I/ / � - i _ '' / % �igned <br />Phone �%! - j `/� �" ` -� , <br />DESCRIPTION: Sewer District <br />Lot_ r Block �3 <br />Plat � ' � � ;. -��_ � Monthly Sewer Service_ <br />�ci <br />Unplatted Descri¢tion Monthly Sewer Constr. <br />Type Permit: ' � _ <br />, _ . � `:- <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By' �-%� <br />Ciry Engineer , <br />e <br />i55UCC� <br />ft. <br />InspectionBy�—) "`- ���`��"' `���+� �— <br />Date Insp^cted ' -'�i�7 � _ <br />N0. <br />b ? � � q.'��� �..,� ���,� <br />_�t.-�;. 'i ��:s< a ff�.F,` ',.,r'y.'�. _ +g _ �.e <br />