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everen <br />� <br />City of Everstt <br />Engineering Oepartment <br />Sew�r Application and Permit <br />N0. [? (��� <br />Service Address <br />Billing Address. <br />City, State, Zip <br />Cwner (Mortga <br />Billiny Name_ <br />Connection By. <br />Address <br />DESCRIPI'IOPJ: <br />Lot <br />Block <br />Division or Additi <br />Tvoa Permit: <br />DATE <br />Utility Account No. <br />Connection Permit I <br />Connection Fee_ <br />Total Fee _._ <br />Signed <br />Customer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_ <br />Ci!y Enginecr <br />Issued <br />Inspection <br />Date Inspe <br />NO. <br />_.. '�!2 <br />:E l-Z'E �� �? <br />