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1 <br /> � �� <br /> He� �+ <br /> A `�, <br /> � y ti �CHART NO. — - <br /> y� � � e��erett <br /> �H � i � <br /> � yH I <br /> I <br /> o�� � Cit ot Everett � - <br /> y TO POSTING � � �- 1 _ <br /> `"� � Sewer Application and Permit ' <br /> H <br /> � y I <br /> t-� H : - <br /> g e y I NO. Z�G s O [�ATE -41a-lL.�- -- <br /> ��y Service Address ---+tN-1�-';ttr-tt �r----- U�ility Accounl No. ---- ------- <br /> HOtn <br /> Billing Address ar�e <br /> i Ci�y, Slale, Zip —_—�«.��:-::n �—�--- Permit Feo $ _ <br /> � <br /> � Owner — Connection Charge � <br /> ' Trunk $ — I <br /> , Connection by _ , A-t;� ' <br /> AdUress ��,:. �.�.c+a-u�-:.�.---- Lateral $ - <br /> � Total Conncclion Charge $ -_.— _ � <br /> � ----Ercrett-kh�--4`�?�*5-'--- <br /> I Phone �Z�_`ii,� Utility Deve!opmenl Fee <br /> ��� � Legal Description: YJater $ -- -- <br /> ' Lot _--�Ta..,, ..; �rt.r,ea�,m�---- Sewer $ <br /> , j ___ Toial Developmont Fee $ I � <br /> _—� � Block <br /> ��'' Plat -- � <br /> � I <br /> ; Unplatled Descdption: _ Sewer Bond Disirict _--}t{,y,o,, f;q � <br /> j �� _ Abutting Lot Line <br /> II <br /> I --- --- _ N, S, E, W _ fl. � <br /> i <br /> Type of Peimit __ _ _ _�,�— _. Approvad By _ --- � i <br /> I -- — . � � <br /> Remarks . I,sued By_ _ . <br /> ' � Customer Signatu o - _ -- ------ ! <br /> ---- - -- - <br /> _ _ li --- -- - -- - IMPORTANT! I <br /> �, !r� � CALL 1-800•424-5555 48-HOURS � <br /> � � � PR109 TO DIGGING - � <br /> i � � <br /> Inspaction By.L_i` <br /> CALL 259-8810 f'OR INSPECTION ���- � , <br /> i Dale Inspected . -__.�-< �.' <br /> SEE S!(ETCH ATTACHED No. ZRC�GU <br />