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everett <br />� <br />City of Everett <br />Engineering Department <br />Sewer Application and Pec�mit <br />`�' ' DATE <br />N0. C 1_ <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />DESCRIPTION: <br />Block <br />Division or Addition <br />r.._.. D......�h• <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee <br />�%aS� �� <br />�7 - 3� _ z q -�i. <br />z <br />Signed Customer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEE SKETCH A7TACHED <br />i. � , � ,, . r.. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W. <br />Approved BY Ciry Eneineer <br />Issued <br />Inspection By ' ". . <br />Date Inspected "� <br />N�. i1G5"1 <br />