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everett <br />��--' <br />�ieY-of-Ewerett <br />� <br />Sewer Application and Permit <br />N0. 2�410 DATE 12/�/!2 <br />.?,/� ��y9 <br />211s ■tat� str��t <br />Service Address � <br />Biliing Add <br />City, State, <br />P_ �;-;,; � ,��. �-%�-8� <br />,S/ zo - zs - f <br />Utility Account No._ <br />Permit Fee ���� <br />Connection Charge�s) <br />■os� <br />Owner (Mortgagor) Total <br />Billing <br />Connection By Clti o! te�z�tt <br />Signed �O° Ml�l�r <br />Customer <br />DESCRIPTIOf�: Sewer District <br />Lot Block <br />Plat Monthly Sewer Service. <br />Unplatted Description Monthly Sewer Constr. <br />Tvne Permit ����_ <br />HemarKs: � _ �v. G <br />-f�.�-v�� eS . /� <br />-� . <br />SEE SKETCH ATTACHED <br />Tru <br />Lateral <br />�g Lot Line <br />N, S, E, W h. <br />Approved By �. �. �al <br />ary enpinae. <br />s. �a <br />Inspection By �� � �jlR-� �'� `� <br />Date l nspected / � ' /�' '�y <br />N0: G�iV <br />INSPECTION "' ' .. <br />m <br />r <br />� <br />