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��� <br />o�x <br />c H <br />Y H fn <br />4 �aC <br />HZ� <br />.e n <br />� M��d <br />NH <br />OF+� <br />�Mg <br />�w � <br />H <br />H <br />gyy <br />(] N <br />��N <br />H O Vi <br />everett <br />� <br />CHART N0. - - - -- <br />TO POSIING / <br />City of Everett " -. �. .. " - L' S � <br />_ - - ,..� �,�_ ���,u t\ <br />i Sewer Application and Permit _ y_ ro rosriNc �� �� 4 <br />;�... , <br />� NO. 2 H � Z% DATE ��j3r�r!`� <br />Service Address �� `��`j j1���T=S� Utiliry Account No. <br />Bitling Address J��-4 N��-¢T�� S% <br />City, State, 2Ip _�(�T �I%1�3 permit Fee g 2n °� <br />I Owner ��Fn NFiE'C'.Q — Connection Charge <br />� Connectlon by Trunk $ <br />; Address Lateral $ <br />Phone _ <br />Legal Description: <br />Lot �� � <br />Alock <br />Plat <br />Unplatted Description: _ <br />�, Type of Permlt � E � ��� � C.'1-iS;,��_ <br />I Remerks <br />IMPORTANTI <br />CALL 1-800•424-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Total Connection Charge $ <br />Utility Ilevelopment Feo <br />Water $ l% C/ . D C <br />Sewer $ �'%T _�n <br />Total Develcpment Fee 5 (lZ•5�. 0� � <br />Sewer Bond Dis�dct <br />Abutling Lot Line <br />N, S, E, W _ <br />Approved By <br />Issued By <br />Custorner Signature <br />0 <br />f�i[R t�FL_�11`.;��ItfZ <br />�' , !'- � . <br />lnspectian By <br />Date Inspected - . � y /j� <br />No. 28137 <br />n. <br />