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everett . .! ��.,. <br /> e . - _. . .� . <br /> c�ri ot e�e�en <br /> Enpineerinp Oepartment <br /> Sewer Application and Permit <br /> N�• OATE <br /> Service Address Utility Account No.___ <br /> Billing Address Connection Permit Fee <br /> City, State, 2ip Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name_ ^ <br /> Connection By <br /> Address <br /> Signed <br /> cmwmcr — — <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service_ <br /> Division or Addition Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Latera I <br /> Remarks: <br /> Abutting Lot Line <br /> "� _ N, S, E, W ft. <br /> —�.a—�=x �' <br /> ✓ <br /> ---- APPruved By <br /> Ciry Enpineer — <br /> — Issued By <br /> Inspection By— �- . � CCc(�.r�.,.�� <br /> y—�--- - _ Date I nspected_ ��/�iL <br /> SEE SKETCH ATTACHED N0. <br />