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� <br />r/ <br />/i�' ��:: ,�_ <br />ever2tt <br />-- � <br />City of Cverett <br />Engineering & Community Services <br />�." _. .:ll ����7 <br />Sevver AppliGation and P�rrni� <br />NO. % `? �' ;'� �I DATE �// ��/� ^ � <br />� ;. , <br />Service Address J f � <br />Billing Address �� "` y � � � �— <br />CitY, State, Zipi:.= r.%, -_,�_- /'^-'U .3 <br />Owner (Mortgagor) �� �=�%� � `—� <br />Billing Name �-'t=�����— �� � ��' <br />C� inection <br />Phone 3 � � — )' / �/ <br />Utility Account No. <br />o,°� <br />Permit Fee '%O <br />Connection Charge(s)_ <br />oy <br />Total Fee �� <br />Signed <br />l_.- <br />Customer <br />DESCRIPTION. Sewer District� '- �, � <br />Lot Block _ ~ j <br />Monthly Sewer Service <br />P!at <br />Unpiatted Description - � � .- " �� -- Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />,� '""�s "e�1 ��,3 ' -�v: �..i� � r -i'Y ,Qr{. ' "' v, . <br />' X� ._..? F.' K�, s�" �"'anr' .' a:'. 6;-� � <br />� <br />Trunk ' <br />Lateral '� ' � � <br />Abutting L��t Line ;; �/ <br />N, S, E, W <br />Approved B�•� ��/ <br />Ciry Ei�e�neer <br />Issued By �'1 �` ; <br />Inspectiun By "� � ��-"�•� <br />Date l nspected� v ��7 � <br />NO. <br />� <br />