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everett <br />�� <br />City of Everett <br />CHART N0. — <br />S� � C`lc�,-� � �2��Se <br />Sewer Application and Permit <br />N0. �v` r� DATE �!r 16, 1987 <br />Service Address ++� �►� w p Utility Account <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name �--- — <br />Connection BY �---- �---� <br />Address��}�- <br />Phone <br />DESCRIPTION: <br />Permit Fee <br />Connection Chargels) �t � � � �• 1171-i5 <br />30.00 <br />Total Fee <br />sp�pial ptii�tp !ra Oed. 1171H5 <br />wt�s Z2�.00 <br />Signed i� <br />cu:tomer <br />Sewer District �d '� <br />Lot le Block Monthly Sewer Service <br />Plat = �._,y:�stq Ml — <br />Unplatted Description Monthly ;ewer Constr. <br />Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1500�4245555 48•HOURS <br />PRIOR TO DIGGING <br />CALL259�811FORINSPECTION <br />SEE SKETCH ATTACHED <br />0?/17/87 4DOfiP1t 6'UORIFd159 #tx <br />Lateral / <br />t�()11i431 <br />Abutting Lot Line� �+�1•� <br />N, S, E, W�' d75.00 ft. <br />HECN 465.� <br />g SNC�! 43.5tt <br />E S6(:N g15.0(7 <br />DRVMY 420.00 <br />� <br />Approved By �� t�--- <br />�nafoear <br />1171-5 s224.W <br />sn '�b�� <br />Issued By .�� _ <br />CJfEq: �i7ti4.00 <br />Inspection By — <br />Date I nspected�'� -�d <br />INSPECTION <br />N0. 26��� <br />