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� U L ` 2l/�,�G� I, CHART NO._�.-_�'��,�-�{ <br /> everett <br /> e <br /> . . �=:-�_�� <br /> City of Everett � l 'I (�I���I <br /> i il <br /> ; <br /> Sewer Application and Permit � -' � <br /> �� <br /> NO. 23Q7� DATE _ " � <br /> Service Addr^ss Utility Account No._ ' � <br /> Billing Address''" � ` .< �' � ' Permit Fee � ' <br /> City,State, Zip �' � ! � "�t � ': _Connection Charge�s)_ �'� �� ' �`� '-/% ' / <br /> . � <br /> � <br /> Owner (Mortgagor�� % � -% �•; : : ': %�( , ,� ;Fotal Fee_ ` � <br /> BillingName '� � _�z �,c._ %l� ,,.•�;. _ �' : , ' !�.'- l, - <br /> ConnectionBy:.° c: , , , ,� ,r_ ,�G ,:;L_ : ��: , ��.: /, �.. <br /> Addre<5- ' l �. i r. Y i,=-r: i...i ,.:., , .��. ::SCgned <br /> Customer �� <br /> Phone . . ' `f <br /> DESCRIPTION: Sewer District % � ' - �--- �1- <br /> Lot Block ��-� . - � , <br /> Plat Monthly Sewer Service -- -' <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: <br /> Trunk � � <br /> Lateral � <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> � <br /> ` (/ /�`— APProved By � ,` 1,_ , . . . / :.. ,ri <br /> T p V �� City Engineer <br /> Issued By ( ; ' t C.r) l r,� •v <br /> Inspection By `�1 �/ <br /> Date Inspected__ / ' � � �9 <br /> SEE SKETCH ATTACHED NO. Z3O74 <br /> �NSPEC710N <br />