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everett <br />e <br />City of Everett <br />En�inseriny Dep�rtment <br />.-+7= zo - z�— ��'- - <br />P� ���� <br />7-`,_�� <br />Sewer Application and Permit <br />Na 21. 3 5 i DATE <br />Service Address Utility Account No. <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />6illing Name <br />Connection By <br />Connection Permit <br />Connection <br />Total <br />Signed <br />Cmtomer <br />DESCRIPTION: Sewer District <br />Lot -- <br />B�� Monthly Sewer Service <br />Division or Addition Monthly Sewer Constr. <br />Tvae Permit: <br />SEE SKETCH ATl'ACHED <br />INSPL'Cll��i': <br />Trunk � <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Enpinem <br />ISSUEd <br />� • � � ,iiQ1[��_�A� . � <br />1- <br />� .- �. - . <br />N0. ��_�J� <br />