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everett ` ,. <br /> � �' � ; - � , �//. <br /> � , �� ��s <br /> City of Everett , ►�{�///J " ' <br /> Engineering Department 1/ " /1/C <br /> Sewer Application and Permit � <br /> �i3 ���4 ' <br /> N0. 2OHS3 DATE : � � : ;; � � <br /> �•- i <br /> =-!r,�_`-�-���� <br /> Service Address , Utility Account No. - <br /> Billing Address Connection Permit Fee — <br /> City, State, Zip � �- _ Connection Fee --- <br /> Owner (Mortgagcr) - " Total Fee <br /> Billing Name <br /> Connection By - <br /> Address_ - Signed ' <br /> Phone cus�o�, <br /> DESCRIPTION: Sewer District <br /> Lot � / ' <br /> Block Monthly Sewer Service <br /> Divisior or Addition Monthly Sewer Constr. <br /> T�,pe Permit: — Trunk <br /> . Lateral <br /> iemarks: <br /> — � p _ _ _ ^ Abutting Lot Line <br /> �i YIA�t N, S, E, W ft. <br /> �- 22� 7S <br /> Approved By_�_ ' <br /> Crty Engincer <br /> Issued By ' <br /> Inspection By <br /> p - Date Inspected <br /> SEE SKETCH ATTACHED N� .� � � �, - , <br /> � r. �_ <br />