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i <br />, o <br />�� SEE SKETCH ATTACHED <br />1�� , , � <br />� � <br />evereri i <br />� ' � 1 <br />� <br />� ' :� i1 <br />; ', I <br />City of Everett �ti, <br />Engineering & Community Services �� <br />� <br />Sewer Appiication and Per�it-_. <br />N0. ;",` �% ��, �% DATE <br />Service Address � �� "' ' ''� <br />Biliing Address <br />City, State, Zip <br />Owner (Moriga3or) <br />Billing Name_ _ <br />- �- , <br />Connection By � <br />Address_ <br />Phone <br />DESCRIPTION: <br />Lot _ Block. <br />Plat � <br />Unplatted Descriprion <br />CHAR NO,, � � � <br />. � � i (-� <br />;l ;1\ <br />l <br />.� •� C< _ � �- <br />� - ��- �c_. <br />Utili:y Account No._ <br />Permit Fee <br />Connection Charge�s) <br />Total Fee -'". <br />� <br />Signed - / i ' <br />Customer <br />Sewer <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Lateral <br />butting Lot Line <br />N, S. E, W <br />_ �/Pproved By ' . <br />City Engineer <br />SUCCI BY — ' � / <br />t. <br />ispection By l C { .��� '��-�"Q� <br />ate I nspected ? "-' �� � _! � <br />