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everett <br />� <br />Ci:y of Evetett <br />Sewer Application cnd Permit <br />No. 23805 <br />DATE ��i� O��'rb <br />Service Address <br />Billi�g Address — <br />G' �" 1�,� 91��tzL <br />City, State, Zip � G. n„ <br />/ ��� <br />pwner (Mortgagor) <br />Billing Name <br />Connection <br />Phone��2 / �/% � <br />DESCRIPTION: <br />Lot B lock � <br />Plat � <br />Unplatted Description <br />Utility Account No._ <br />Permit Fee_�� <br />Connection Chargels). <br />Total Fee._—� <br />Signed <br />Sewer District_ <br />Monthly Sewer <br />� <br />e�-- <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTiUN <br />Lateral <br />�butting Lot Line <br />N, g, E, W <br />4ppfOVCd BY City Engmcer <br />Issued By ['� � <br />I nspectio n <br />Datelnspected <br />No. 23805 <br />� ) • !�� �. <br />ft. <br />