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11 <br />Jam. <br />City Everett r do �! <br />Enuineering Department <br />Sewer Application and Permit <br />NO. L' <br />DATE <br />Service Address ___ _— <br />—_ Utility Account No <br />Billing Address ---- <br />Connection Permit <br />City, State, Zip----- <br />Connection Fee_ <br />Owner (Mortgagor).__--_--- <br />Total Fee <br />Billing Name —_ <br />Connection By —___--_._— <br />- - <br />Address__ —.—_— ------ <br />Signed <br />Phone <br />DESCRIPTION: <br />Lot <br />Block _— <br />Division or Addition —_ <br />Remarks: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Customer <br />Sewer District__ <br />Monthly Sewer Service, <br />_ Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By I . <br />City Engineer <br />Issued <br />Inspection By - <br />Date Inspected 7y <br />NO• 20710 <br />