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CHART N0. — <br /> everett <br /> � ' + , <br /> �. <br /> City of Everett SE��.— To CN��i'i��'�' <br /> 3 L� � � � <br /> i � �` <br /> Sevwer Application and Permit <br /> N0. GJr�J�T DATE ,�� = i' ` — _ <br /> ) <br /> Service Address % � - Utility Account No. <br /> ., � > <br /> BillingAddress ' i - — �PermitFee �— <br /> � . � G :_ . i'� ',.,.'::' .. : � <br /> City, State, Zip -- - :' �Connection Charge(s) � <br /> > <br /> Owner (Mortgagor) � �' ' � Total Fee <br /> Billing Name ' '' '--' <br /> Connection By � <br /> Address Signed_ � <br /> Cuswmer <br /> _i , � `..� <br /> Phone � — <br /> i .. -- <br /> DESCRIPTION: Sewer District ' '� <br /> Lot � Block � Monthly Sewer Service <br /> Plat � . , i � '_, , <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk - <br /> Type Permit: ` % <br /> Lateral _ <br /> Remarks: <br /> Abutting Lo: Line <br /> N, S, E, N1 ft. <br /> — Approved By _�'. '"�_i,;, ,- . : r� <br /> City Engineer <br /> IMPORTANT! <br /> Issued P,y ��� '�`' " "` � <br /> CALL 1-600-024-555548•HOURS .,% <br /> PRIOR TO DIGGING � <br /> CALL 259�8817 FOR INSPECTION <br /> Inspection By / �c�'e��y�� <br /> vatelnspected 5��6 "�G <br /> SEE SKETCH AT"fACHED Np, Z�3�E T <br /> INSPFCTION <br />