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1 <br /> everett ' <br /> � �` Q � � <br /> � ° <br /> City of Everett /� <br /> Enpineering Department � ° � � r <br /> Sewer Application and Permit - ` " <br /> NO. �� _�_ c_ :7 ._• DATE <br /> Service Address Utility Account No. <br /> Billing Addrese 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: Sewcr District <br /> Lot _ <br /> Block Monthly Sewer Service _ <br /> Di�-ision or Addition Monthly Se��:er�onstr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: z �, � ,� � <br /> Abutting Lat Line <br /> /-.'r� S�o �_�/ -2- G N, S, E, W_. ft. <br /> S 1 <br /> Approved By <br /> City Engineer <br /> Issued By <br /> Inspection By �' j <br /> Date Inspected_�-2-�� <br /> a— <br /> SEE SKETCH ATTACHED N0. �' �_ � � � <br /> IIVSPECTION <br />