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everett I CHART NO. <br /> I <br /> � J�ivT To C/✓Fl/'+.,,Ji ///2% f�G: <br /> / <br /> City of Ever�tt <br /> Sew�r Application and Permit <br /> N�. Z5S7Z DATE . , ., <br /> 9ctober=3��6 <br /> Service Add�ess— 12326 19th tivP S E Utility Account No. <br /> Billing Address Si�l! Permit Fee- +.. � <br /> av v <br /> City, State, Zip �werati w�4 9Q�OM1 Connection Charge�s) <br /> Owner (Mortgagor) Dcxiald t;�ny Total Fee <br /> Billing Name �� Spetial Ut111ty Or'dinante 1i?1-65 <br /> I� 5e�er 3471 .00 <br /> Connection By .+_..a�«�� <br /> Address Signed ' <br /> Customer <br />� Phone <br /> i { y <br /> i DESCRIPTIOV: Sewer District f +'J'tJ`� Q0j`�' ���`�'��""� "k�k <br /> —+c�«� �#� <br /> Lot Blor,k -- k����'� <br /> Plai Monthly Sewer;ervicg��, <br /> Un latted Descri tion �tID1.li <br /> P P — Monthly Sewer Const���Jl �� <br /> Type Permit: New Cpnr�;Ction <br /> Trunk 'r��� 'U.OJ <br /> Lateral <br /> Remarks: Paid trv LSD ;13 Aqre:=,n��nt, tfai) <br /> — Abutting Lot Line <br /> irvoice fer side sewex ccnstructiun ;sir,nad 'c� N, S, E, W ft. <br /> _ le:�el prcK:�rty owner) t�e�cre 11/Zi/L•G tu: <br /> _ Celia Strc�iu <br /> 3"tUt1 Cer?�P St. ALFRLL' �. TtL^rL <br /> Approved By <br /> Everntt, Ylll 4E%Ol CityEneineer <br /> IfdPORTANT! �s:,t,;�x•:t E. !acLrc�;i <br /> Issued By <br /> CAL L 1 S001t24•5555 48-HOU RS <br /> PRIOR TO DIGGING <br /> CALL 259-9811 FOR INSPECTION <br /> Inspection By ` <br /> Date lnspected � � � �G <br /> SEE SKETCH ATTACHED Np, G5H9G <br /> INSPECTION <br />� <br />