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CHART N0. <br /> euereft <br /> � _ <br /> ' :=NT TO !f1/JFT�'�/G' <br /> City of Everett �/�/�,7 <br /> 5e�nrer Application and Permit <br /> No. 259fi1 DATE .__-_-��f-�-+� <br /> , <br /> Service Address � � � � �� G� � Utility Account No. <br /> Billing Address r�A I11 G Permit Fee_ <br /> �� ��—� <br /> City,State, Zip Connection Cha�ge�s) <br /> Owner (Mortgagor) �— � Total Fee <br /> /� '� <br /> Billing Name 11;12;Uh :U:Ih7fN1 �Xu�i!^90:1 t; i ' <br /> Connection 6y �;���1 <br /> � � Signed � ��;r+u�, ^��t� �n'� <br /> Address :_ ��j�!'n� �1(i,qU <br /> Phone <br /> DESCRIPTlON: Sewer District <br /> �ot Block — Monthly Sewer Service <br /> Plat <br /> U�:;'latted Description Monthfy Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N, S, E, W ft. <br /> - Approved By <br /> CiLV Engineer <br /> IMPORTANT! Issued BY <br /> CALL 1-800-024-555548-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8611 FOR INSPECTION _� <br /> Inspection By —1� Ga,�r�i,,="n <br /> Date Inspected � �— �� ' �6 <br /> SEE SKETCH ATTACHED N0. �`��s1- <br /> IN�PECi10�1 <br />