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�t � j" —,� <br /> � �� �� � <br /> � _ � - � ��-�s <br /> �.: <br /> City of Everett � p-- a. 4 —^ �� <br /> Engineering Department <br /> Sewer Application and Permit ``'"`��� <br /> rvo. 212 G�} DATE <br /> Service Address � Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee � � <br /> Owner (Mortgagor) Total Fee � <br /> Billing Name <br /> Connection By_ <br /> Address Signed " <br /> Customer <br /> Phone <br /> DESCRIPTIO� Sewer District <br /> Lot / <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> — Approved By <br /> City Engineer <br /> Issued By <br /> Inspection By <br /> Date Inspected � 2�" �7 _ <br /> a <br /> SEE SKETCH ATTACHED N0. � ��. �(,j � <br /> i19SF�_��:��I(j��l <br /> ��i. <br />