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�-_-,� <br /> � <br /> I <br /> I <br /> �� � '^� � � <br /> everett . � <br /> l�— ,�7 --2.R S <br /> 6 _ z. 4 - � � <br /> c�ty ot e�e�acc <br /> /� <br /> Enpineerinp Department /.l'„� �l� <br /> /J <br /> $ewer Application and Permit � <br /> NO. �� �. �� i} �J DAT � — <br /> - i3f���= �- <br /> Service Address '�'-'-�-- Utility Account No. — <br /> 8illing Address Connection Permit Fee <br /> City,State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> customer <br /> Phone --- <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service — <br /> Division or Addition Mo,�thly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: ,- � , <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> �'i6 . . . � �'9 <br /> Approved By <br /> Ciry Enpinea <br /> — Issued By <br /> Inspection By <br /> Datelnspected <br /> a <br /> SEE S�SETCH ATTACHED Nn. � 1 ? G 5 <br /> If!'I!'�.-r:l-I� ��! w <br />