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F <br /> � <br /> eKRrett �!� <_- . `_ /� <br /> � �(��-� � -- �� - 5� � <br /> City of Everett <br /> -- -- ?6 — ;�,�" � <br /> Engineering Department / �����i '����, , � <br /> Sewer Application and Permit ; <br /> N0. l 121� DATE ! ! �%'% %� % � � <br /> Service Address ' Utility Account No. <br /> Billing Address Connection Permit Fee � <br /> City,State, Zip _ � v Connection Fee - <br /> Owner (Mortgagor) � Total Fee <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> ' � Customer <br /> Phone_ <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service_ <br /> {�i <br /> Division or Addition MonthlySewerConstr. � ,`i <br /> Type Permit: Trunk i <br /> „ . � <br /> � ;� ,��-.�� � <br /> _� i. , � Lateral f <br /> Remarks: � . /- . <br /> - ' , ' - Abutting Lot Line <br /> : <br /> N, S, E, W ft. <br /> _�� "-2�- S <br /> Approved By <br /> — CitY Enpineer <br /> Issued By <br /> i <br /> Inspection By <br /> o Date Inspected <br /> SEE SKETCH ATT<1CHED N0. ? �_ � '� �' <br /> !i;5PECTIUiV <br />