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everetf , , ', <br /> � _ — ,. / % � ,' . / <br /> , <br /> , _ I � � c,, `/ ,g�:J ��� � ^� ;�-- <br /> I,' � <br /> City of Everett <br /> Engineering Department � � <br /> �- �� <br /> Sewer Application and P�rmit <br /> �i 3 � `�`� <br /> N0. �' � � �) O DATE <br /> Service Address ' Utility Account No. <br /> Billing Address Cannection Perrnrt Fee_ <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee _ _ <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> - . � Customer <br /> Phone <br /> DESGRIPTION: Sewer District <br /> Lot <br /> Monthly Sewer Service <br /> Block_ <br /> �ivision or Addrtion Monthly Sewer Constr. <br /> — Trunk <br /> Type Permit: , ' <br /> T � Lateral <br /> Remarks: �' %L'�' `i'i� F.P�� 1i u-:� ,—o <br /> `,� A6utting Lot Line <br /> f�� �'s ;//.- •'...—a' s�E:�-/� N, S, E, W ft. <br /> � <br /> .yY�.i CaNNccT/aN. _. <br /> '— ---- Approved By <br /> City E�pineer <br /> Issued By <br /> �nspection By /�/�� ��=- `�c �'� �— <br /> Date I nspected_L�= � i`f • <br /> 3 <br /> SEE SKETCH ATTACHED N�• " �,j �; � !� <br />