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�vt►rett <br />-e <br />c�cy ot e�erett <br />Enpineerinp Oepartment <br />Sevver Application and Permit <br />N0. L �. ?�r �l DATE T. <br />Sei vic� Address <br />Biliing Addr�ni <br />City, State, Zip _ <br />Owner (Mortgagor) _ , <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot � <br />Block <br />Division or Addition <br />Tvpe Permit: <br />�� f �, �, �� <br />�� <br />,��_��_��_� <br />. . <br />,; �,� <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />Signed <br />Customer <br />SEESKETCH ATTACHED <br />fi,;���:��_r) I �C^a <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engineer <br />Issued <br />� <br />Inspection By '4'' %�-'x'��'��`�' <br />Date Inspected 6/ %�17, <br />NO. �1.��4 J <br />