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t <br /> . _. , <br /> everett - �— <br /> � �� � �� ' � <br /> � <br /> City of F.verett � ' � <br /> Engineering Department <br /> Sev��er Applicatian and Permit n <br /> Jc: �iJG <br /> No. �t,0 2 0 7 " DATE <br /> Service Address ' :- Utility Account No. — <br /> Billing Address Connection Perm�t Fee <br /> City,State, Zip / _ Connection Fee <br /> Owner (Mortgagor) " Total Fee — <br /> Billing Name <br /> Connection By � ' — <br /> Address Signed — <br /> Customr.r <br /> i ` ,' a•: • <br /> Phone_ <br /> DESCRIPTION: <br /> Lot — / <br /> Block �'% <br /> Divisian or Addition ' ' <br /> Sewer District <br /> -- PAonthly Sewer Service — - <br /> Remarks: ' �' ; _ <br /> Monthly Sewer Constr. <br /> .�,, /'c�,., 7 !'�1-�r s.v,z' x � - �- — <br /> — Approved By " <br /> City E��9���crr <br /> „--i�c � sa �.�� � �--�- k« ���.._ _ <br /> �ssu,� av <br /> — Connection By <br /> — Inspection By ���Q �,°^� <br /> . i <br /> Date I nspected �/ " �?� <br /> � — <br /> SEE SKETCH ATTACHED <br />