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everett <br />� <br />City of Everett <br />Engineering Uepartment <br />�. <br />�".�c�r�`f_ _ <br />�! �-.�r>�n I/'Lf,�7S��fD <br />\ �, ' � <br />Sewer Application and Permit <br />rvo. 20697 DATE -" <br />Service Address �'� �' " Utility Account No. <br />Billing Address Connection Permit I <br />City, State, Zip ' ' ' Connection Fee_ <br />� <br />Owner (Mortgagor) - Total Fee <br />Billing Name � <br />Connection By <br />Address - ' ' <br />i�ti � :- <br />Signed <br />Customer <br />Phone . <br />DESCRIPTION: Sewer District <br />Lot � � `=� <br />Monthly Sewer Service. <br />Block <br />Division or Addition '/•�� �� " Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />i r!"i :- , . i <br />Latera <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />CitV Engineer <br />I ssued <br />Inspection By �'!J <br />Date I nspected �//d � � '� <br />/ <br />No. ?0697 <br />