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everett �� _ =; _- �� <br /> � � �-� � j � . <br /> : <br /> � . _�s: , , i . . <br /> � <br /> City of Everett ' <br /> Enpineering Department <br /> Sewer Application and Permit 3 41�12 <br /> NC l.�OOGq � i DATE <br /> Service Address� (D�� Utility Account No._ <br /> ��i - � , . <br /> Billing Address �" j ' � Connection Permit Fee _ __ <br /> . <br /> . '? . <br /> City, State, Zip - ''/ A � Connection Fee <br /> Uwner (Mortgagor) � '� ' ' ' % ' , Total Fee <br /> Billing Name �'�� =- <br /> Connection By � ' -�` �`�V � <br /> ' i_ <br /> � <br /> . <br /> Address / ' ' ��' � Signed <br /> Cusromer <br /> Phone � -3 - .:, <br /> DESCRIPTION: . <br /> Lot ::•�.-�,�'"'°=J �i <br /> , <br /> Block ' % � � � � _- - <br /> / y ,/` <br /> Division or Addition = �'� � <br /> Sewer District _ <br /> Monthly Sewer Service <br /> Remarks: . , %' i,�C� ' <br /> Monthly Sewer Constr. <br /> y' . <br /> �D ��2 � 8� S� Guu„t.. � APProved BY �y� '�';'� !!.'� <br /> � Ciry Engineer <br /> �� ISSUBd BY � <br /> Connection By — <br /> Inspection By�IL � �1`�"'"� — <br /> Date Inspected � � �`� y 7' � <br /> iID <br /> SEESKETCH ATTACHED <br /> C'.�:IPL�;i iJi: <br />