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CHART NO.— <br />everett <br />Lej <br />City of Everutt <br />Sewer application and Permit <br />No. 23067 DATE - <br />/2 -2 0 g <br />7 <br />Service Address 3 �� �—t Utility Account No. <br />Billing Address Permit Fee_ <br />Z. <br />3� <br />City, State, in Connection Charges) <br />Owner (Mortgagor) ptal.Fee <br />Billing Name <br />Connection <br />DESCRIPTION: <br />Lot j— Block <br />4 r, <br />Plat <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />Signed <br />Sewer <br />Monthly Sewer Service -- <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By QOV E�Blnee <br />Issued By <br />v / <br />Inspection By--W- <br />Date Inspected 30 A10U 97 9 <br />No. 23067 <br />INSPECT ION <br />