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everett /��' 3 �� � <br /> � � � - 3 � L � - .5� <br /> City oi Everett 2' � 3 — 7 L <br /> EnNne�riny O�p�rtment ��i4� <br /> Sewer Application and Permit ' <br /> N0. 21 �� � DATE � � � �� � <br /> � <br /> Service Address � ' ' Utility Account No._ <br /> Billing Address / -7 = � � ';✓ �' Connection Permit Fee. ' � <br /> City, State, Zfp ' % 1 � ' Connection Fee_ -" " '" <br /> Owner �Mortgagor) '�'" � __ Total Fea <br /> Billing Name � <br /> Connection By�� _ - � . :t y c � . \ <br /> Addreu Signed � �� �. <br /> � CUSIORNf ' <br /> Phone <br /> DESCRIPTION: Sewer District , <br /> Lot Y ' <br /> Block.�,�_ Monthly Sewer Servir,e <br /> Division or Addition � � � i , , � Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: j �. . - <br /> /; ..� '��l�I J �� /�� . i/ �i =i L8t8fA� _ <br /> .a ----�•--� <br /> Remarks: " - , �g9 ' <br /> "� � Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By � ' � � <br /> ci�v e�oio.« <br /> Is:ued By <br /> Inspection By <br /> Date Inspected <br /> Y— <br /> SEE SKETCH ATTACHED N0. 21 �O �I <br /> I��� :I��i:li�)N <br />