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�ni �vv. <br /> evcrett .. . <br /> � ,1` 7 <br /> City oi E;rerett � ' <br /> r•. <br /> Engineering & Community Services •-- <br /> Sewer Applicatior� and Permit <br /> NO. `Z `Z(j 8 9 DATE � �' - �� � <br /> Service Address ' ' '. Utility Account No. <br /> E3illing Address__ ' R/ Permit Fee � !,��.7 '�� <br /> City, State, Zip__ __ ___ Connection Chargels) <br /> ;� <br /> Qwner !hiortgagor) _ Total Fee_�� '' <br /> Billing Namc_ <br /> Connection By __ _______ <br /> Address __ Signed �+� '-°/ <br /> cutto,ne, �- <br /> Phone <br /> DESCRIPTION: Sewer District_ <br /> Lot _ Block------ ----- <br /> Plat ______.____ Monthly Sewcr Service__________� <br /> Ur.platted Description � , _ __ Monthly Sewer Constr. <br /> i __ "/. • . ,� <br /> Type Permit: � ,/ + ' . Trunk---_—__-----_---- -- <br /> Lateral <br /> Remarks: <br /> i Abutting f.ot Line <br /> -- - �1• ', F, W— - -- — ---- ft. <br /> -- � ---i <br /> --- _ APProved BO.. , ' --^- <br /> —.-- --- c��v E�;B������,— <br /> __ - --- Iss�icd [3Y--- �- <br /> r — — <br /> -- ------- ------ Inspectiun C � ---- <br /> y------.. ---- - Date Inspected— - <br /> - ------ - --- _._..—..— •- <br /> SEE SKETCH ATTACHED rvo. 22689 <br /> INSPECTION <br />