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everett <br />City of Eve" <br />Sewer Application and <br />No. 23913 <br />Service Address <br />Billing Address <br />City, State, ZiP-L-`� <br />owner (Mortgagor), --_- <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Block <br />Plat <br />Unplatted Description <br />DATE <br />SEE SKETCH ATTACHED <br />CHART NO. !�- 6 �5� <br />Utility Account No. <br />Permit Fee_— <br />Connection Charge(s) <br />Total Fee_ <br />SignedCustomer <br />Sewer District <br />Monthly Sewer Service <br />--Monthly Sewer Constr. <br />Trunk_, <br />Lateral__ <br />,butting Lot Line <br />N, S, E, W-- <br />INSPECTION <br />FIN <br />M <br />kppro-td By <br />City engineer <br />issued By�- ---- <br />Inspection By- —X—L <br />Date Inspected <br />No. 23913 <br />