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CHART NO. <br /> everett <br /> � � Pc>�,�b a S 97 <br /> ,, EnIT To !N // <br /> City of Everett <br /> Sewer Application and Permit <br /> N0. Q4777 DATE �� e, 19M <br /> 3e29 Sbor� 1►nnw 16051-5 _ <br /> Service Address Utility Account No. — <br /> Billi�g Address r.0' laac sW permit Fee 3�•00 <br /> City,State, Zip <br /> �� s�. �• �� Connection Charge(s) ��•� <br /> r. M. wiLes.4 ooa..itaaa ao.00 <br /> Owner (Mortgagor) Total Fee <br /> N. 11. 9di1dln4 OaualCants Osdia�nw 1722—i0 <br /> Billing Name �� S 500.00 <br /> Connection By <br /> Address Signed c�:�ome� <br /> Phone 3�ht7e5 <br /> eood II <br /> DESCRIPTION: Sewer District <br /> Lot =� Block Monthly Sewer Service w�� <br /> Plat ��~� <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: tbv Oooirctioe <br /> �ateral _ <br /> Remarks: Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> 71. R. Th��1 <br /> City Engineer <br /> H. DOa�d <br /> Issued By <br /> Inspection����� <br /> Date Inspected /^a 9�7 <br /> SEE SKETCH ATTACHED ND• Z4T�7 <br /> INSPEC'.:ON <br />