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evvrett <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit' <br />Rol <br />DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing N. me <br />Connection By---- <br />Address— <br />DESCRIPTION: <br />Lot <br />Division or Add <br />�asTc'O <br />3 a - 2- <br />2gT ?C <br />Utility Account No.. <br />Connection Permit F <br />Connection Fee_ <br />Total Fee_ <br />Signed <br />Remarks: NtpL,0 C'n,6"6!AC= :. Yin JJ _—� <br />7 -- <br />SEE SKETCH ATTACHED <br />11.8//. <br />Sewer District_ <br />Monthly Sewer Service__ <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N.S,E,W <br />Approved By <br />Ci,Y Engineer <br />Issued <br />ft. <br />Inspection By <br />Date Inspected___ �� S <br />No. 21190 <br />