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everetl <br />e <br />City of Everett <br />Engineering Department <br />Sewer Application cnd Permit <br />� <br />NO. ;_ _ " . ,_ DATE _ <br />Service <br />Billing <br />Utility Account No. <br />Connection Permit <br />City, State, Zip Connection <br />Owner (Mortga�or) Total Fee_ <br />Billing <br />Connection <br />Signed <br />Customer <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition, <br />n <br />SEESKETCH ATTACHED <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N. S, C, W <br />Approved By <br />City Engincer <br />I SSU C(� <br />Inspection By �f� / r�= - <br />Date I nspected_�`��L ��� � <br />� � <br />N0. �� �;-, , <br />