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� everett <br />; : <br />�e , <br />; <br />; <br />� <br />� City of Everett <br />j Engineering & Community Services <br />; Sewer Application and Permit <br />i N0. ' `l.: �' c� /' DATE �,�! U� _ �1,� <br />�` <br />�� - ; <br />Servme Address— � / <br />Billiny Address_ <br />City, State, Zip <br />O���ner (Mortgagor) <br />Billing Name <br />Connection By � ,• � __ � <br />, <br />Address ��� <br />Phone <br />DESCRIPTION: <br />Lot � Block � J E <br />Plat � : / (:� �. /,z,'�. <br />Unplatted Description <br />Type Permit: .-:t_, _ <br />CHART NO.�Za�2 '� _ <br />/`�O S / Lr .� <br />,— �o-- �g <br />�' —"'�� • <br />Utility Account No. <br />Permit Fee <br />Connection Charge�s) <br />Total Fee -- �_ <br />Signed_ % � <br />cu:�omrr <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Remarks: � i• � � �. S_� <br />Abutting Lot Line <br />�c .. e-,.z S.i�, /� ��� � 2.S' N, S, E, W <br />G. �.-,.ti. /<>. H . ti;� �s'� �� <br />i <br />I <br />p — <br />i <br />� SEESKETCH ATTACHED <br />� , i ..- � � ;. <br />,,� ; , . '�� r�'e.::� .. _ ,`�59� *.� �'ir°�`` <br />_i� �: <br />Approved BY' �✓` <br />Ciry Engincer <br />I ssu ed <br />Inspection By ��-�-c / ��-.-n.-a�7-1� <br />Date Inspected_ � — (� — % � <br />N0. <br />.��; ��'"�..r-za� .n <br />t:u � _a� a� �,;:�. <br />, �,„*-�'s_^,�, <br />� <br />