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I i � <br /> eyeteN l/ — % � ` - ' v <br /> e � - - ,- �,� . <br /> �, � �, _ <br /> City of Everett <br /> � <br /> Engineering Uepertment , ' <br /> Sewer Application and Permit <br /> �i ;� �)�f f <br /> N0. `z Q 8 g rj DATE <br /> Service Address - � % � '/ � � Utility Account No. <br /> Billing Address � ✓���� Connection Permit Fee <br /> City, State, Zip ' �` Connection Fee <br /> Owner (Mortgagor) �' `' � ' " " _ Total Fee <br /> Billi�g Name <br /> Connection By �1i' - <br /> � Address � �% Signed <br /> Customer <br /> . Phone ' : ! <br /> � <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Monthly Sewer Service <br /> Block <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> i Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> . c.F< w, U[< G�' mw.n,nn, <br /> /r <br /> 7t,Y� b� Y c�„ <br /> , <br /> ,�, '� � PL 9,.5 / <br /> „ ��� � , Approved By_ <br /> � Ciry Engineer <br /> d., c....���T �. <br /> — Issued By <br /> '' G ' <br /> .�..D.r ' w 6 —' �..,..� ,.�.., � <br /> , <br /> � „�a., <br /> cb...�:e< T 4 " �..� -�.� . " ,;7 l 1 <br /> Inspection By � � ' <br /> Date I nspected � — � � �.S <br /> a <br /> SEE SKETCH ATTACHED N0. � I� �s � ;i <br /> �.2..�,,��i.=�:l-���('?i <br />