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1 ' / '� <br />�e���rPn U — �D." Z. � ` _._. <br />� f � �''/� <br />� , � -,�,.�� r, _ <br />� <br />- i�%�'°' <br />C:ity of [verett <br />f:ngineering Departmr.nt <br />;5���er i4��alicatior� cand Perrr�i%' <br />N0. 20�1_C� DATE _r - - <br />Service Address__ __ Utility Account No. <br />Billing Address_' '= Connection Permit Fee <br />City, State, Zip .�''•� f' T� _ Connection Fee <br />Owner (Mortgagor) � , , Total Fee _ <br />Billing Name _ <br />Connection By - , - <br />Address._ _ Signed _ <br />DESCRIPTION: <br />Lot , <br />Block <br />Division or Addition_ <br />Tvpe Permit: <br />3 <br />/ <br />SEESKETCH ATTACHED <br />IN"r>PECTIOii <br />� <br />Sewer District_ <br />Monthly Sewer Service __ <br />Montlily Sewer Constr. <br />Trunk _ <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved 6y_ . <br />City Engineer <br />I SSUCd <br />Inspection By��!"_ � _ <br />Date I nspected 3/0 �.s <br />rao. 2U91_0 <br />