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everetlr <br />� / / � ��/ <br />C�ty of Everett <br />� f <br />_�_ ; �- , -�" �J,,' <br />� � ��..1 <br />L/ . . <br />Engineering Oepartment .^ i <br />Sewer Application and Permit <br />N0. �OH6�, DATE ' � � ,�F�� <br />Service Address " � � � ` ` � � ' ,. Utility Account No. <br />Billing Address - Connection Permit I <br />Ciry, State, Zip_ �`'- ''" �� Cennection Fee_ <br />Owner (Mortgagor) - _ = � �, Total Fee <br />Billing Name - <br />Connection By " '' _ <br />�aa..,..� -- `.�ned <br />DES^•RIPTION: Sewer District <br />Lot _ Monthly Sewer Service ' <br />Block <br />Division or Addition ' '' %" ` Monthly Sewer Constr. <br />Tru n k <br />T...... D......i. ' __ . . ... <br />Lateral <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved [3Y—: <br />City Engincer <br />Issued Bv ' <br />Inspection <br />Datelnsne <br />r <br />NO. ?(l;�Ej �. <br />