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e�-erett ' <br /> � . � ��� �� ���'�_' . .r <br /> City of EvereY: <br /> Engineering Oepartment <br /> S�rnre� Applicat�on and Permit <br /> 3372?. <br /> N0. L G I � U DATE <br /> 5ervice Address__ Utility Account No. _ <br /> Billing Address Connection Permit Fee <br /> City, State, Zip__._ Connection Fee <br /> Owner (Mortgagor) Tota� Fee <br /> Billin3 Name <br /> Connectiun By <br /> Address Signed_ <br /> Customer <br /> Phone _ . <br /> DESCRIPTION: Sawer District _ <br /> Lot <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Con,tr. <br /> -- Trunk_ _ <br /> Type Permit <br /> Lateral <br /> Remarks: r�„ j i' 7 :;7�,, `' '� � _ <br /> Abutting t�ot Line <br /> N, S, E, W ft. <br /> Approved By �, <br /> Ciry Engineer i <br /> Issued By _ <br /> Inspection Ry �� <br /> — Date I nspected____�'/G� /?'� I <br /> 9 / � <br /> SEE SKETCH ATTACHED NO. � (� 7 � O <br /> , � � <br /> 1 <br /> . � �, <br />