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D <br />City of Everett <br />Engineering Ocuartment <br />Sewer ,Application and Permit <br />NO. <br />DATE _ <br />Service Address_ <br />Utility Account No. <br />Billing Address_ <br />Connection Permit <br />City, State, "Lip <br />Connection Fee_ <br />Owner (Mortgagor) <br />Total Fee <br />Billing Name <br />Connection By -- <br />Address — <br />Phone -- <br />DESCRIPTION: <br />Lot <br />Block _— <br />Division or Addition <br />Type Permit. <br />Remarks: <br />6 <br />_ to w e2 - -,V <br />t <br />L.-stirc�_._�ic <br />-t, "v - !L ` <br />a <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service, <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N,S,E,W. <br />Approved B <br />I <br />Issued By <br />Engineer <br />Inspection By �D �� �` "-"� <br />Date inspected ! G <br />NO. i <br />