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everetl / , �' • � 'r, . <br />, <br />� �h S .� n � ��' ��75 <br />� ;��./l�� <br />C' f Everett � <br />ity o . � <br />Engineering Oepartment � <br />�- <br />Sewer Application and Permit <br />No. 2.0965 DATE /I� � 11 <br />� <br />Service Address " � � �' ' � �' �� �� � - <br />�-> i !'� ,�,..� � <br />Billing Address <br />City, State, Zip <br />,'�� , ' i "'- , 1l �il �l l' <br />Owner (Mortgagor) � �' l � � c ' � r � ' ` � ��—� <br />Billing Name I`( t f <br />'� <br />Connection By � - ' { � - <br />Address ; i ' l � i ' ` 't . ' � <br />i'; l. � I .-" . ti ' �_' <br />' . I . <br />Utility Acco��nt No. <br />Connection Permit I <br />Connection Fee__ <br />Total Fee <br />I � J C <br />�� �- ��-� <br />. ' �: <br />�t , <br />Signed �'' ' ' <br />Cusrorrier <br />DESCRIPTION: � <br />Sewer D?strict � <br />0 <br />Lot i Monthly Sewer Service_ � <br />Block__ <br />pivlsion or Additio��....t � �' � t-' ` Monthly Sewer Constr. , s <br />� Trunk � <br />� <br />a <br />SEE SKETCH ATTNCHED <br />Lateral <br />Abutting L�t Line <br />N, S, E, W <br />� ,. <br />Approved BY—.. ,. , , <br />Ci1V Engmne� <br />ISSUCd By _ <br />� � -,;�X,_�.(�.�� <br />Inspection By— " ��� <br />Date I nspected �' ' o � <br />NO. ?(1!���,r <br />