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! CHART N0. j'� "_ "�n 'a.q ' S <br /> . . � <br /> everett <br /> e = : -_ :: . <br /> __,� . <br /> . �� , <br /> City of Everett <br /> Sewer Application and Permit <br /> ,; <br /> N0. 232�1 DATE ��,�� -` ��/��� �� — <br /> � .i / -�- <br /> Service Address � '� ' � <a/` Utility Account No. <br /> ' r ,� <br /> Billirg Address } � J 1 'J��`t'� � �L'��—� Permit Fee J G <br /> `' ��fi. ( `�'/ Connection Charge�s) �' <br /> City, State, Zip�=-' �r'�'� : <br /> Owner (Mortgagorl. % !s7�%+^? � ,�y"'�'' Total Fee —'-- <br /> Billing Name /��'+'+�p^' <br /> Connection By <br /> Signed � <br /> Address a�;,���„�� <br /> Phon.: <br /> �, '' <br /> Sewer District__f�i,* /'��'"'""c� <br /> DESCRIPTION: � � <br /> LotE�-. � �`" Block � �'' ' � Q <br /> ;:f� Monthly �ewer Service_ <br /> Plat � � �-� /'�� .> � �/C%� <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: _ <br /> y Lateral <br /> i r .A-vc �,/�r,��- <br /> Re arks: Abutting Lot Line <br /> N, S, E, W__ ft. <br /> � � r�C� /�J , <br /> �< � ; <br /> u � �sT«-_ . — T, �� , Ftc:. <br /> Approved By <br /> Ciry Enginecr <br /> _ Issued By <br /> �� <br /> i �, <br /> i <br /> InspectianBy �� �/ << 2� ~ <br /> I .C' �L' - , <br /> Datelnspected_.� <br /> SEE SKETCH ATTACHED N�• Z3Z71 <br /> IYJSPLC I '���„�J � <br />