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CHART N0. <br />. <br />evereit <br />� <br />City of Everett <br />Sewer Appli�ation and Permit <br />/'� <br />No. 23781 <br />DATE �LO�= 15, 19s0 �_ <br />�3y= 52aA itt��t 8.1�• Utility Account No._ <br />Service Address �on� <br />Permit Fee <br />Biiling Address <br />City, Scate, Zip <br />Connection Chargel <br />Total Fee <br />Owner (Mortgagor) <br />Billing Name <br />Connection By Cit of E�R=�t� <br />Phone <br />sof� <br />Signed �s Milles <br />Custorner <br />Sewer Dis?rict <br />DESCRIPTION: <br />Lot�— Block Monthly Sewer Service <br />Plat -----'—' Monthly Sewer Constr. <br />Unplatted Description <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Laterai <br />abutting Lot Line <br />N, S, E, W. <br />Approved By e • Nazs�n �_ <br />CitV Engineer <br />E. 8o�d <br />Issued By — <br />� <br />Inspection By /; � (% l//" , � , ,• � _ <br />Ua'ie Inspected �r � � ' — �� <br />No. 23T81 <br />