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CHART NO. X 12-ZS '�I <br /> � e�•eretl • <br /> � <br /> �rED y_Za-� I <br /> City of Everett � <br /> Sewer Application and Permit <br /> NO. 23600 DATE - ' d <br /> Service Address ��� y � �-�"� �'�� ��- Utility Account No. �y�� <br /> Billing Address_-3 �� �� Permit Fee Sp f <br /> City, State, Zip O:D Connection Charge�s) l�6� � <br /> Owner (Mortgagor Total Fee �n �l <br /> Billing Name_1`�/ � <br /> n 1 <br /> Connection By �"-"� - J i /��,� <br /> Jr ^ / � /1: ,+ , <br /> Signed�l�'• ';; l •" <br /> Addf855 Customer <br /> Phone ��S- �9/7 <br /> i <br /> t, <br /> DESCRIPTION: Sewer District�_ <br /> Lut Block Monthly Sewer Service �c c<o� <br /> Plat <br /> Unplatted Description " ��`✓�� � �� ^' �r�/ Monthly Sewer Constr. <br /> i � ' � Trunk .3 �c � ���'�'3 <br /> T pe Permi : /�, f � _ I <br /> ' Lateral � �� �y�-3 <br /> Remarks: � /f ^ � � � �� ' <br /> ,L+ir . � Abucting Lot Line <br /> � / N, S, E,� �m� ft. <br /> . � � � ,, <br /> �, <br /> Approved By � . ���`'���' <br /> City Engineer <br /> C� �j� j <br /> Issued By -� � -�1r`>` <br /> �� ���j <br /> Inspection B <br /> Date Inspected S �'3-� <br /> � <br /> SEE SKETCH ATTACHED N0. Z�6OO I <br /> I �J <br /> INSPECTION � <br />