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' � <br /> � <br /> CHART NO. S I `i '?�i -S <br /> I� everen <br /> ; L 4`fSUtc�� GU� R-T GutiJ� C S <br /> � e �.�YT E z�Tu , �� � �� �T� <br /> Qds��u s-�-ad <br /> � City of Everett <br /> Sewer Application and Permit <br /> N0. 23214 DATE ��/% /�- � _ <br /> Service Address l �G�i ?lf� ���� Utility Account No. <br /> _ .��•. <br /> Billing Address %' Permit Fee <br /> City, State, Zip /' Connection Charge(s) <br /> Ov�ner (Mortgagor) Total Fee I <br /> Billing Name_ � <br /> I <br /> Connection By - � <br /> Address Signed <br /> Customer <br /> � <br /> Phone �` <br /> DESCRIPTION: Sewer District I <br /> Lot/-'�-7J ,_ • —"— <br /> �' 3 Block��_ Monthly Sewer Service ��`lt�" =`�`�'� �j i <br /> Plat ��f��.,_—, i' ��_ <br /> i <br /> � Unplatted Description Monthly Sewer Constr. i <br /> I • _ — Trunk � <br /> � `` Type Permit: � ' <br /> �� � Lateral <br /> 1 ; <br /> �,� — . p� � <br /> Remarks: � Abutting Lot Line � <br /> I � � �/ N, S, E, W ft. ; <br /> i � � <br /> 'h <br /> � <br /> i <br /> — � � Approved By - <br /> \\� CiP: Engineer <br /> / I <br /> � I <br /> ; Issued By ' <br /> � � <br /> I <br /> � 4 <br /> � i <br /> �i� � Inspection By � <br /> ' � Datelnspected <br /> I ' <br /> i A i <br /> SFE SKETCH ATTACHED N0. Z3Z1�F <br /> i <br /> i INSPECI'ION ; <br />