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everetl , <br /> e � -- <br /> , <br /> � , <br /> Cir/ of Evarett <br /> Enpineerinp Depertment <br /> Sewer Application �nd Permit <br /> N0. , DATE _ — --- -- <br /> Service Address Utility Account fvo. — — <br /> Billing Address Connection Perriit Fee _ — <br /> City, State, Zip_ Connectio� Fee <br /> Owner IMortgagor) Total Fee_ <br /> Billing Name <br /> Connection By — <br /> Address Signed a�a�om�� �-- <br /> Phone_ — <br /> DESCRIPT ION: Sewer District_ <br /> Lot — Monthly Sewer Service - <br /> Block _ <br /> Division or Addition Monthly Sewer Constr. <br /> __ -- — Trunk -- <br /> Type Peimit: � _. <br /> Latera I___ — <br /> Remarks: _ Abutting Lot Line <br /> N. S, E, W - ----(t. <br /> �1na. �a�i'c.s��1.- <br /> — Approved By <br /> Ciry Enpmeer <br /> Issued By - — <br /> � `� — <br /> Inspection By � 'f-� { �r„' � <br /> _ _ ___ Date Inspected_ � "/� --- <br /> o—--- --- � t r, , <br /> SEE SKETCH ATTACHED N0. <br />