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@Y@fE�l- <br /> � � ����� � <br /> City of Everett ''���� <br /> Engineoring Oepartment � ' � <br /> Sewer Applicatio� and Permit l�- 3`-' � z <br /> NO. L .L J ._i � DATE <br /> Service 4ddress �b �- Utility Account No.__ <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> ; <br /> Owner (Mortgagor), Total Fee <br /> Billing Name_ <br /> Connection By <br /> Address Signed _ <br /> Customer <br /> Phone_.__ <br /> DESCRIPTIGN: SewerDi,:rict ' ' ' <br /> i <br /> Block__ Monthly Sewer�ervice ' <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 /> > <br /> Approved By � ' <br /> Ciry EnBineer � <br /> Issued By <br /> Inspection8y ��'��L��t-�'--' <br /> _ Date Inspected 7 � 7 � <br /> e � <br /> SEE SKETCH ATTACHED N0. ;� _I 5 � n <br /> INSPECTI' ; <br />