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CHART NO. <br />� everett <br /> � ,' <br /> s <br /> if � . � <br /> I d.��,,�✓��_'� � <br /> City of Everett ���� <br /> i, <br /> Sewer �►pplication and Permit , <br /> N0. 24760 DATE p� a a �� --- <br /> Service Address � � � 3 3�""� Utility Account No. `QI — — <br /> � <br /> Billing Address ��' C� �� 6 � Permit Fee_.� — <br /> ;ity, State, Zip���¢���C.C�''� ���O!� Connection Chargzls� � <br /> Owner (Mortgagor) Total Fee_ �/ — <br /> 8illing Name_ <br /> Connection By -- <br /> Address_. Signed <br /> Customer <br /> Phone .�Q3 .,2.2 � - �c,/o2 / <br /> DESCRIPTION: Sewer District_ <br /> Lot loc!: I ����¢ Monthly Sewer Sen�ice <br /> Plat • ,G" -��J <br /> U atted Description Menthly Sewer Constr. I <br /> Trunk <br /> Type Permit Lateral <br /> Remarks: Abutting Lot Line <br /> � C �yPC /O✓1 <br /> N, S, E, W ft. <br /> r�J P �w� <br /> s� 3� - �y _. <br /> ��� � <br /> Approved By <br /> Ci Engineer <br /> _ Issued By � ' �-�'"""� <br /> � <br /> Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED N0. Z�+76O I <br /> IIdSF(=CTION I <br />