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r,1c;C 3-9'4'p <br />e reft <br />� <br />Ch�y of Everett <br />SE�wer Appl��ation and Permit <br />No. 23�19 <br />DATE � - `�_ �`v <br />� l;'� Utility Account No. � �� � <br />/t - v � <br />Service Address � "� - <br />/ , -• / � �- Permit Fee . �'� . <br />�illing Address�� �� — <br />_ y� <br />%' � -;• � �/.: u� Connection Charge(s) <br />City, State, Zip � / � -,;: � �" <br />i _ - ri <br />pwner (Mortgagor) ,f" <br />Billing Name� <br />--- �--- <br />Connection BY .. <br />" � / (.' �� �'� ✓ - .�' � <br />Address - <br />Phone <br />DESCRIPTION: <br />Lot � <br />Plat <br />Unplatted Desci <br />T��pe Permit: � / - <br />Remarks: <br />Block�--- <br /><//� <br />SEE SKETCH ATTACHED <br />Total F <br />' <br />$19�ed�i� Customer� <br />� <br />Sewer District � � L—� <br />i <br />Montlily Sewer Service <br />Monthly Sewer Constr. <br />INSPECTION <br />Trunk_ J �� '� <br />Lateral <br />Abutti�-lot Line ` U� ft. <br />� N�;�S, E, �N <br />, �`. ' , / <br />qpproved BY �itY Engineer <br />Issued BY----=—�-'�— <br />Inspection <br />S � - <br />Date!nspected 5 � � <br />No. 23519 <br />