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J <br /> everetl CHART NO. �` �s-Z�1 - `� 1 <br /> ��� L ,f. -- <br /> e � - . � � <br /> City of Everett ' <br /> Engineering t's Com��unity aervices • <br /> Sewer Application and Permit ` <br /> �- �� - � j <br /> N0. ! �_ ( J �' DATE �-" � i- i ,i� <br /> Service Address �� �� - � ' ' <br /> � '`" � ' "` - �� ' Utility Account No. - <br /> Billing Address_ `� r=J •� ' �,;-. � - � <br /> � �� � `� � Permit Pee 5'Q ��� <br /> ^'. ' ' —� s-- <br /> City, State, Zip��-�- % G%�t , i _ ;'1 J Connection Charge(s) -��� <br /> Owner (Mortgagor) _ i _ `��� <br /> Total Fee / •`-� <br /> Billing Name '� � / � <br /> Connection By_ _ �_- , <br /> ,; � ; <br /> Address ' � ' ' ;' <br /> Signed.� c.:; ^--z'� ' ' <br /> .r� �; <br /> Customer` ~ � � <br /> Phone _ �i � �— �!- L� / ( ' <br /> DESCRIPTION: �, � <br /> �,, Sewer District -� �� %� /L <br /> Lat�__ Block <br /> PIaY . <' ,, ;--"'J -" � MontSily Sewer Service _ " . .r. �� <br /> ... <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: "'/ - � Trunk �- �'� <br /> J <br /> — Lateral ' <br /> Fiemarks: — <br /> — Abutting Lot Line <br /> , N� S� E� W — ft. I` <br /> J <br /> �: <br /> APProved By_ . ,:%%-..., ..., , <br /> Crty Engineer <br /> . <br /> Issued By - t- � <br /> c----_ <br /> i'. <br /> Inspection �" �J �' <br /> _ �.. <br /> g — _ Date Inspected� "� �- �/ <br /> _ SEE SKETCH ATTACHED N0. / � <br /> ii'!SI'�-r i lUf, � <br /> � � <br />