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, CHART NO. � �n�'�q���— <br /> , � <br /> � everelt f-�d s�'•.''r'a � ' - <br /> I �� <br /> i` <br /> i City of Everett <br /> iEnqineering & Community Services <br /> � Se►wer App�lication and Permit <br /> ; <br /> � � � � , � �� � � - - _ <br /> , , . <br /> N0. �. _; l,� ��* DATE <br /> i - �, • / �:� r, <br /> ,� � J � !_,,,r /.,�;:,_� '✓ Utility .4ccount No. ' �' <br /> ' Service Address _. '' _ <br /> � , a,- i/• ;' . Permit Fee � v <br /> � Billing Address � � � � � ' � � � � '� � � <br /> i • ^��G <br /> ; � r , j ;.;1� '%r ;�D Connection Charge(s1 U ' <br /> I City, State, Zip �.,-- <br /> 4 �' �J Total Fee � u <br /> � Owner (Mortgagor) �-'''-� "" � '�'l' <br /> � <br /> �� Billing Name '='-r``: ' "�✓ <br /> �._ i <br /> f Connection By_ , ;�.L� � �� (���_ -- <br /> Signed <br /> � Q(fdf055 _ Cusmmnr <br /> � <br /> G, >� - '-/ `�`�=� <br /> � Phone -- — <br /> ; � �".. . ,� /1- <br /> Sewer District ' <br /> � DESCRIPTION: -- ,- p <br /> Lot 1�---- Block _..:--� Monthly Sevaer Service <br /> �� ::r�..: - ' �,.._ / , % � <br /> i ��8t;'iX...�_ . . ,. .� — <br /> Unplatted Description _Nionthly Sew,er Constr. <br /> � l'runk �� �"' . <br /> ,, a /� �,__,_.�. <br /> l Type Permit: fJ_ ,� i . `' Lateral — � <br /> � <br /> I � <br /> � <br /> Remarks: Abutting Lot Line _ ft. <br /> N, S, E, W..— <br /> � ---- <br /> l ,,4J- , ' <br /> � Approved Eiy� <br /> Ciry Engineer ! <br /> -----�— , —c � �:: <br /> � <br /> ssued B �..__"�=-- <br /> I. <br /> Y <br /> I <br /> � <br /> i <br /> � <br /> 1 � �l <br /> � � ;nspection By �-`""'"�'� � `'�— <br /> � �v� 7 — <br /> I _- - ---_ _.__ Date Inspected_._ <br /> � s _ -- , N 0. <br /> � SEE SKETCH ATTACHED <br /> "i�,-:;': :'i I��:�. 9 <br /> � <br /> I <br /> ; , <br />