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everetl <br /> � . • (.� _-_l,� • i. <br /> City of Everott <br /> Engineering Uepartment <br /> Sewer Application and Permit <br /> N0. DATE _ -- <br /> Service Address Utility Account No._ — _ <br /> Billing Address Connection Permit Fee_ <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee _._ _ <br /> 6illing Name <br /> Connection By <br /> Address Signed _— _-- <br /> Curlomer <br /> Phone_ — __ _ <br /> DESCRIPTION: Sewer District_ <br /> Lot-- <br /> Monthly Sawer Service <br /> Block -- <br /> Division or Addition Monthly Sewer Constr. <br /> -- -- Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Linc <br /> " N, $, E, W_ ft. <br /> � <br /> Approved By <br /> Ciry Enpineer <br /> Issued By <br /> �_ . <br /> Inspection By ��� t-�L�L�"�' `i"'-� <br /> Date Inspected__� �'�� �7 C� <br /> Y � <br /> SEE SKETCH ATTACHED N�• , � ' �� � <br />