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J <br /> CHART NO�L��T�s� � � <br /> everett o� s ��r� , I <br /> e �� - <br /> /o - Zil7 � <br /> City of Everett ♦ � <br /> E�gineering & Community Services � �� �� �� <br /> � 78 i� 1 <br /> • • • � SEP `.819 <br /> Sewer Application and Permit . � <br /> CITY OF <br /> EVERETT. � <br /> N0. � � J � 7 DATE � � _ Cn ineerin� �QPt. � <br /> Service Address � p�� -`�'�" " ` � « Utility Account No. + <br /> / �/ I <br /> BillingAddress_ ��/ �� / f"����" c �=��%"'e • PermitFee j� - <br /> r. ` �-� /�� _�.�---� I <br /> ' City,State, ZiU r, ' "� '`G�� ��`�G-3 Connection Charge(s) <br /> _ C/ � <br /> � / 9U / <br /> ; .-r��'-�,�-.+rCi� .���.'���:r•n�� Total Fee � <br /> Owner (Mortgagor) - , ;� <br /> Billing Name-' ��-�-�F= ��r��:' ,', f✓ <br /> �-� �r , i <br /> ` � � <br /> Connection By :i' i -�' .- 'G� �' —�...--�_ ' , i� ' <br /> ; � �/ �.�, // /: <br /> ���' �- � ' �[ L�°- !,( ' l "/ <br /> Addrnss '� �� � -�-'�i:�� ..,� Signed i� � i �,: � i �: i <br /> cuvumer ! <br /> ' Phone � 5 -� �i •�� <br /> DESCRIPTION: ;iJ ��ti s SewerDistrict <br /> Lot BIocIJ �-; �; r Monthly Sewer Service = � � '� <br /> Plat ,;•?. iJ• _.�> _ ., L., . . � .,i,_. .,� � <br /> Unplatt�d Description Monthly Sewer Constr. � <br /> �� �- Tru nk <br /> Type Permit: ��,,- � _ <br /> Lateral <br /> Remarks: S _ 7- <br /> _ Abutting Lot Line ?l l, ! j <br /> � N, S, E, 1N !(,�- 1 ft. <br /> Approved By <br /> Ciry Engineer <br /> Issued By - <br /> Inspection By �'-�-- <br /> - / � <br /> Date Inspected y�- 7'� <br /> 0 <br /> SEE SKETCH ATTACHED N0. . . <br /> INSPECTION <br /> -�.. <br />