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, _...__.t,._ .r_ x � <br /> ' CHART NO,�"��— <br /> � evere�tt <br /> � � � � �.� � ��� <br /> C �' ��' <br /> City of Everett <br /> � Engineering & Cornmunity Services �:�� � <br /> � <br /> ! Sewer Applicati��n and Permit <br /> ; <br /> � <br /> . , <br /> N0. ` �' �' � DATE l I � U -- — - <br /> j ° — �. ._ <br /> j <br /> � Service Address '� ' �' � �- Utility Account No. G� '� ` ' <br /> i '- �::i <br /> BillingAddress '' ` ' ('•% �� � ` / PermitFee -.. :<: <br /> I ,.' .l.i.' , c: „ <br /> j City,Scate, Zip 4- � � �'` 1Ji1.� . / JG :- :- Connection Chargels) <br /> { <br /> � Owner (Mortgagor) ��1(t, �.ii'•11 � - '- `, ' , Total Fee ` <br /> � , ,�, i i <br /> Billi��g Name_ <br /> iConnection By__ - " -� -�— <br /> � Address Signed c�s�o�,a� � j — <br /> j Phone_ ��J— J 7�� <br /> I <br /> I DESCRIPTIQN: Sewer District � f_' ' �-�-� <br /> ' Lot ' 31ock_ <br /> , � Nionthly Sewer Service <br /> � Plat . . . : � ; , , _ <br /> � Unplatted Description Monthly Sewer Constr. <br /> � <br /> ' — Trunk �� ' �`� � <br /> � Type Permit: . �t i i. . � <br /> � — — - <br /> Lateral <br /> i <br /> ' Remarks: <br /> � Abutting Lot Line <br /> � N, S, E, W ft. <br /> � <br /> � APProved By �� /�G .a i;�� ; ._�,_1 <br /> j Ciry En9ineer <br /> I ' <br /> — �SSLI@� �'� ' �� � __�_ / <br /> i <br /> I <br /> — _ �� <br /> Inspection By �' �-�- -��� �_ - --� <br /> � Date Inspected_ % J��B <br /> , � <br /> SEF SKE .TCH ATTACHED NO. <br /> � Gx+ _ � u, � .� . . �. <br /> , ._ rt� / q i . " ' � f : <br /> � �` ' ..E,�":n � :�:°.-°� 2.`:� F� �,- � _..,� <br />