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CHART NO. <br /> everett <br /> � ! <br /> City of �verett ' <br /> Sewer Application and Permit <br /> N0. �4980 DATE �/ ���/�/ <br /> 1 � � <br /> Service Address tility Account No. <br /> � �0 �% <br /> Billing Address �'-' Permit Fee <br /> City,State, Zip �-�.-c,�v( �� 9���yConnection Charge�s) <br /> ����1� � u� <br /> Owner (Mortgagor) �C'-r��� �-�'-�—•-r Total Fee � <br /> Billing Name <br /> Connection By — <br /> Address Signed <br /> cu:tomcr <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot Block <br /> Monthly Sewer Service <br /> Plat <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: � <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> /� � � <br /> Approved B��- //f ��� <br /> Ciry Engincer <br /> — Issued By_ '�i� <br /> � <br /> Inspection B�—���`�/^"'�" _ <br /> _ Date Inspected //" "��'rJ' <br /> SEE SKETCH ATTACHED N0. 24980 <br /> IFi5PCCTION <br />