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, <br /> , >. .. - ,� <br /> CHART NO.� `3-5 -Z�J��_ ' <br /> everett y : <br /> . <br /> � �-7�� <br /> City of Everett / �,a� �� <br /> Engineering & Community Seroices � <br /> Sewer Application and Permit � <br /> N0. �' `� h t) i� DATE �// �, �i ;�_', <br /> Service Address��/ �� - % �'�! ' _;� . Utility Account No. :% � ! <br /> Billing AddreSs'' Permit Fee >�� � <br /> ....��,_,: . . ....- / i'-�i -��— <br /> City, State, Zip - �: / ,: Connection Charge(s) � ���� <br /> ,.�--�- . , <br /> Owner (Mortgagor) - � �- � ` _ Total Fee ��' <br /> Billing Name <br /> Connection By - " _ � <br /> � <br /> Address Signed". �<<` - lf �''�if/�" !C% � � <br /> Customer <br /> Phone - ��_� ' � <br /> DESCRIPTION: Sewer District / �� <br /> i <br /> Lot Block _ �� <br /> Plat -' -- ._ Monthly Sewer Service ` <br /> Unplatted Description Monthly Sewer Constr, <br /> �- Trunk �/. / r' <br /> Type Permit:^ - <br /> Lateral <br /> Remarks: <br /> •— Abutting Lot Line <br /> N, S, E, W ft. �� <br /> Approved By <br /> Ciry Engineer <br /> Issued By � <br /> I nspection ��='�`—� <br /> Date Inspected - D ' <br /> e <br /> SEE SKETCH ATTACHED N0. , l+ ..r <br /> I� Pi�iJ�ili)�� ! <br /> t <br /> �� <br />