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evPcs_- <br />� <br />City of Evereit <br />Engineering Department <br />-: -_� �— ��i— �. <br />–_t _ � .. <br />� i _ <br />Sevorer Applicotion and Permit <br />N0. _ DATE <br />Service Address_ <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection 8y_ <br />Utility Accoui t Nc <br />Connection Permi[ <br />Connection Fee <br />Total Fee <br />Signed <br />cu:romcr <br />DESCRIPTION: Sewer District _ <br />Lot <br />Block Monthly Sewer Service_.__ <br />Divisior, or Addition Monthly Sewer Constr. <br />Type Permit: Trunk _� <br />SEESKETCH ATTACHED <br />,, <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />_ tt. <br />.4pproved By <br />Gry Engineer — <br />Issued <br />Inspection By <br />Datelnspected 6 ' <br />N0. - - _ i:; <br />