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n <br />I <br />0 <br />everett <br />e <br />City o{c�erett <br />Engi�eering & Community Services <br />5e,,rver Application and Permit <br />�_ <br />IVO. F' G l� ." i DATE I%- ^"• i'l/ <br />CHART NJ: � %�� .; i,s - /_t,/ <br />i <br />;� <br />,: , <br />y�sr�E-� { <br />y—�o-�� �. <br />�i� <br />; <br />Service Address�=-' �%� ' ' � �•Utility Account No. -3 ' � %�' �'" %j _ O G <br />Billing Address �`� '�� � � �� ! � Permit Fee � -' ✓/' <br />City, State Zip� -,�__� '`�✓�-' /� � , ' �nnection Charge�s)_ i� - f.� �` _ <br />j, 7 .,� <br />Owner (N�ortgagor) � , .al Fee _ _ _ <br />Billing Name -�-� �--- <br />Connection <br />Add <br />.- � ' '� : % <br />DESC�IPTION: <br />Lot �r Block - <br />Plat . i : � ..f' i T <br />Unplatted Description <br />Type Permit: jL-. -- ' � � <br />r, - <br />/i <br />; > >, 2 <br />Signed� _ <br />Customer <br />SEE SKETCH HTTACFIED <br />I� , � INSPECTION <br />i i� / 1� <br />Sewer District �-� '=�-^- - — <br />Monthly Sewer Service � ' U <br />Monthly Sewer Constr. <br />� ^� <br />Lateral - ^ � <br />Abutting Lot Line <br />N,S,E,W <br />_.. ii <br />Approved By - . �G'-. _-_,�-� <br />Ciry Engineer � / <br />;' //! <br />Issued By ` -''• _ "�� <br />Inspec[ion B � �1�/'�""' ' " <br />Date l nspected�/ ��J �� <br />N 0. �' <br />e <br />� <br />� <br />� <br />