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everett � - <br /> � !%"t�Y,�'r - .C�� _ <br /> City of Evarett <br /> Engineering Uepartment <br /> Sewer Application and Permit . <br /> NO. . '._ 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 /> Billing Name <br /> Connection By <br /> Address _ __ Signed <br /> Cuslomer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service _ <br /> Division or Addition_ Monthly Sew2r Constr. <br /> Type Permit: Trunk <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S. E, W ft. <br /> Approved By <br /> City Engineer <br /> Issued By <br /> Inspection By C. Brossard <br /> o Date lnspected_�%��C� <br /> SFE SKETCH ATTACHED Np, 1 o j <br /> � <br /> 2..3 �. ._ <br />