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everetl / / �i <br /> CHART NO.,L=_f`(,Z l't'-;� ! <br /> � I � <br /> .� �`'�y�=�L� <br /> � � _ -��_ � � � <br /> City of Evcrett �'_ �__(p // ; <br /> Engineering & Community Services ' <br /> Se�rer Application and P�r ' 4`��� � <br /> rr�tt ,� � <br /> I <br /> IVO. _ , )� : i DATE ; - ' � <br /> Service Address ' ' � <br /> �—. Utility Account No. �' �-' " . . . � _� ' <br /> Billing Address ' <br /> ' Permit Fee l <br /> City, State, Zip - j <br /> �" '_ Connection Charge(s) <br /> Owner (Mortgagor) , - _ I <br /> Total Fee � � i <br /> Billing Name. ---- � <br /> I <br /> Connection gy_ � <br /> Address , ;. i <br /> Signed ' _ '� <br /> z.,j..,.�::�`1 � <br /> Phone_ I%�� ' j// 'h Cuvomer <br /> DESCRIPTION: � <br /> Lot__`_ g�ack Sewer District _y <br /> P�`�� --- Monthly Sewer Service ' � <br /> Ur,platted Description_ <br /> _ —Monthly Sewer Constr. <br /> Type Pennit: _ _. ---- — <br /> - � Trunk " _^_ <br /> ;, <br /> Remarks: Lateral <br /> -- Abutting Lot Line <br /> N, S, E, W <br /> �_ it. <br /> Approved By ` • <br /> --�—���- City Engineer � <br /> - issued By�__ _ �, <br /> � ; <br /> - �Inspection B / `�„Lrt{;y� <br /> ' — Date Inspected /C� ��� �` <br /> SEE SI(ETGH ATTACHED , <br /> : _ . _ .s-._ NO. �: ;J <br /> . . . . r�- -,.,,^ac.---�.-.. -.-... _-_. .,�.��. _.. <br />