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eve'rett � <br />3r�zj` <br />City of Everett rd 5 <br />Engineering Department <br />Sewer Application and Permit <br />NO. 20715 DATE <br />7- <br />Service Address i - ; Utility Account No.. <br />Billing Address Connection Permit F <br />Cil)', State, Zip Connection Fee <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection By <br />Address r <br />Phone — <br />DESCRIPTION <br />Lot <br />Division or <br />Type Permit: <br />SEE SKETCH ATTACHED <br />!NSPECTION <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer <br />Issued <br />Inspection By. r , `-, "S 5--t+ -m <br />Date Inspected_ 7 7 �= "71- <br />NO. 20715 <br />