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1 <br /> i <br /> CHART NO. L/•� .3E • �'�'�� S� <br /> everetl � <br /> �,. <br /> e - . <br /> ��s.�� � � <br /> .� �� , ; <br /> City of Everett <br /> Engineering & Community Services r � ' <br /> S�wer Application and Permit , ; <br /> N0. E= [' 3 �� °� DATE CS�Y/7 r3� <br /> Service Address 5��-� _ —{6.'!�.c. Utility Account No. <br /> Billing Address � ^/0 , � . _ - ri�' . Permit Fee % ' --�-- <br /> City, State, Zip � _/ •��iti %j'-�'d Connection Chargels) � <br /> f,, . <br /> Owner (Mortgagor) . ' -"_ Total Fee "'��—r_. , _c� � <br /> Billing Name__ <br /> � �� . <br /> Connection By �=r -'i <br /> Address / � L ` • � <br /> Signed -_„__�L :_.r� .� � <br /> Cusromer <br /> Phone <br /> 1 <br /> DESCRIPTION: Sewer District / S( /�.r � <br /> Lot Block <br /> Plat Monthly Sewer Service _ -' • -i U <br /> Unp'atted Description ���-.�.�. ��- � _; i Monthly Sewer Constr. <br /> _ �/ ��. =>. / / ;� <br /> Type Permit: ";j, , � � Tm��k <br /> ' ✓ Lateral � • -' _� � <br /> Remarks ,�e. 0 ���c«�- ilG ,QGu- <br /> �butting Lot Line <br /> C�s�- , cc�'7`.r-�..., . � � C N, S, E, W ft. <br /> C��� � ///, fi� � �' r_t� <br /> — — 4pproved By- _. �.' • . <br /> City Engineer <br /> i -� � . <br /> . Issued By '"' --.-�, <br /> Inspection By_S.�s�l���� <br /> Q Date lnspected '� — 3 --� <br /> SEE SKETCH ATTACHED N0. <br /> li i!:��i�C I i.': <br /> � <br /> -�.. <br />