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, <br />� <br /> CHART NO. � � ��! �' <br /> everett <br /> �i <br /> e f. ,�:�s��.,� � <br /> ; <br /> City of Everett �� _�^,� C� <br /> , ~� / <br /> $ewer Application and Permit �-� ' <br /> � C,:� 5� I <br /> N0. 22�6� DATE � �_ i <br /> Service Address Utility Account Na. � <br /> i <br />'� Billing Address _ Permit Fee -- I <br />! City, State, Zip_ _ Connection Ch2rge(s) -"`�+- � <br /> � <br /> Owner (Mortgagor) Total Fee � <br /> Billing Name <br /> _ �._.__ <br /> Connec4ion By � <br /> i <br /> Address Signed - <br /> cuscort,cr <br /> Phone � <br /> DESCRIPTSJN: Sewer District <br /> Lot_ Block— <br /> Plat Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. ; <br /> �i <br /> Type Permit: _ . _.- <br /> Trunk <br /> — i <br /> Lateral <br /> Remarks: i j <br /> Abuttiny Lot Line � <br /> _ ' � N, S, E. W fL <br /> � � . 'i � <br /> ..� <br /> � ' ! <br /> � /v < . f� <br /> � � � / APProeed By � <br /> �fi �/p��-:� ( i.ri� 6ryEngmeer � <br /> I <br /> ',1 <br /> ; Issued By _ i <br /> ;;� ,. ,�.,i � r�.� :�,�: � <br /> Inspection By— ti � i <br /> � Datelnspected � � � �� � <br /> � SEE SKETCH ATTACHED No. 22$66 I <br /> � <br /> � Ih!SPIiCTIOi! <br />