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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />ND. 24107 <br />DATE <br />Service Address 2e28 Crand <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By Citr of srarei� — <br />Phone <br />DESCRIPTION: <br />Lot _ <br />Plat <br />Unplatted Descr <br />Block <br />Utility Account No._ <br />Permit Fee >gona <br />Connection Charge(s)- <br />Total Fee_ None <br />Signed <br />Don Hiller <br />Customer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />yN.. .., �..... <br />■�nai <br />Remarks: <br />,c <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By A.R. Theal <br />city Engmeer <br />Issued By E. Bond <br />Inspection ey <br />Date Inspected/ `' 2. <br />7- <br />NO. 24107 <br />