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everett <br /> e ��, ��� �� <br /> City of Everett � ;' / - ,'_ �� . � <br /> Engineering Department <br /> sr; '^ ;, ,',-� <br /> Sewer Application and Permit - � � <br /> N0. i �. r, �' �� DATE <br /> Service Address S�Z____��f+ .r/,q F 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 /> DESCRIPTION: Sewer District <br /> ; �ot 1 —3 <br /> � , Block Monthly Sewer Service <br /> Division or Addition �"/. �l���a�� �� f,(� ���� MonthlySewerConstr. <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> `�o � � ' — <br /> � o Z� <br /> ^� � ' <br /> Approved By <br /> City EnBineer <br /> � Issued By <br /> � � .i � L <br /> Inspection By <br /> e <br /> Date Inspected <br /> SEE SKETCH ATTACHED Np, { ) lj � � <br /> INSPECi', ' <br />