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everett <br />� <br />City :verett <br />Engineering & Community Services <br />Sewer ,Application and Permit <br />CHART N0. "' 'J� <br />b <br />�i�' s T ""�"� <br />�—z,�'_'7 &' <br />� <br />N0. >>'�_i �� DATE �;//! I7 I <br />Service Address / " -� � ��-� "I --� i ,. `J. l.`� Utility Account No. � ' � /'- ' � ' �' ', <br />Billin Address f � �7� �� - c:_ Permit Fee J�j ��' <br />9 �r <br />� / ��� <br />/ i., � <br />City, State, Zip -�.-- ' - C'�/ .::�/'Z %�,.'( � Connection Charge(s) � �U <br />� . �'. . /� �-� '/ <br />Owner (Mortgagur) �' .--�' .---, , � •. : 1. •.-. ; .�= ; ,., Tutal Fee J �� <br />Billing fJame ,. �� <br />Connection By --!-- --C---- _ <br />Phone � 7 �- �Ci �' O _ <br />DESCRIPTION: <br />Lot � � Block_-_ <br />Piat _ ( ,r_.._ _ . , ,.! !i�. r;�. <br />Un�latted Descripti�>n <br />i <br />,� � <br />Siyned % i''-�`'�"G% (/l , .'�' ,'�i•`�"„°7'�- _ <br />Cusmmer <br />Sewer District <br />- � � <br />�Qonthly Sewer Service - • S �> <br />_ Monthly Sewer Constr. <br />— TrunK � �� <br />Laterai <br />Abutting Lot Line <br />N, S, E, W ft. <br />,� <br />SEE SKETCH ATTACHED <br />5 �s /O �; c M! .� LM1�.t r�_', <br />� c� f <br />1 �y ��} �r� 4 y b <br />Approved By_ 'I , - <br />Ciry Enginect . � <br />Issued By '^ ' --%'' � _ <br />.� <br />r. � <br />.. . ,. . /- <br />�:i' 1 ST"\'!:�'NY �, �i: .� sYJ'' <br />t r <br />4:t.. 'F �; n SS�. • .; tYt" e4�cNN; <br />