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l✓a%v ' `dd� // -30 - rff <br />eD <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />N0. 22b 1 DATE /O' X— /2' <br />CHART NO. ' <br />Service Address % �1 /� Utility Account No. <br />Billing Address.- <br />r, P <br />City, State, Zip.? ----c" �G'` • r/ 703 <br />Owner (Mortgagor) <br />Billing Name�- <br />Connection By — <br />Phoie <br />Permit Fee <br />Connection Charge(s) -- <br />J <br />Total Fee—� -- <br />Signed <br />Customer <br />DESCRIPTION: Sewer District— <br />Lot— Block Monthly Sewer Service <br />Plat <br />Unplatted Description ;;�/, y;7- l Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N S E W <br />Approved 8�_=— •!;yG' -_ <br />City Engineer <br />Issued By <br />Inspec <br />Date I <br />SEE SKETCH ATTACHED <br />NO. ?2v47 <br />INSPECTION <br />