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i <br /> ICHART N0. ------- <br /> H <br /> p � � everett <br /> � y y e _ . . - _ _ �� ,�os�, �5 �o,�,�� <br /> K y � - " _ <br /> O 6 O . _. . � - ' ' ' <br /> �' y � City of Everett � <br /> � � �c <br /> ° " F� Sewer Application and Permit . <br /> � � R _ <br /> � • <br /> Z y � �-: . �-- � :. - . ., ___ .'. . <br /> � � y NO. Z797O DATE p�tat,e�_&TL?98- <br /> N <br /> O N <br /> � � � Service Address —.-G32��2-=3 l'"'ity Account No. �, <br /> H O N 10204 - Ilothall l�ay cr �i <br /> Billing Address <br /> City, State, Zip t+ " wn ���"' — Permit Fee $ I <br /> Ow�er , , Connection Charge <br /> i Connection by <br /> Trunk $ <br /> � Lateral $ � �I <br /> Address <br /> Tolal Connection Charge $ i�� nn <br /> Phone _qni Utility Development Fee i <br /> j Water $ —1�' ^^ <br /> � ��1 Legal Description: I <br /> �► Sewer $ 4�� on <br /> i I.ot _,y <br /> 1 Total Development Fee $ ��^ ^^ — I <br /> �� ?lock I <br /> !� Plat _ <br /> Sewer Bond Disirict nond T <br /> Unplatted Description: I <br /> i __ Abutting Lot Line I <br /> N,S, E,W — ft. <br /> �'�� Type ot Permit ��f Approved By � <br /> Remarks _ Issued By j <br /> , Customer Signature I <br /> �, � . <br /> IMPORTANT! <br /> �� � <br /> I '�t�� CALL 1-800-424-5555 48-HOURS /_ <br /> l PRIOR TO DIGGING �— <br /> \ �'l� <br /> Inspection By I <br /> CALL 259•8810 FOR INSPECTION Date Inspected ��� � y� <br /> I <br /> I <br /> SEE SKETCH ATTACEIED No 2��7U I <br /> I <br /> If•i51'FCl ION � <br /> I <br />