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(everett P l _ "� J <br />s <br />City of Everetty <br />Engineering Department <br />Sewer Application and Permit <br />NO. DATE <br />Utility Account No._ <br />— <br />Service Address------- <br />Connection Permit Fee <br />Billing Address_ -- <br />-- <br />Qir--CN PA Y (+\J 6 <br />Connection Fee <br />— <br />City, State, Zip <br />------ _--- <br />Tctal Fee_ <br />Ow .ai (Mortgagor) --------- <br />Billing Name <br />Connection Ry_— <br />Address_ <br />Signed <br />ces rimer <br />Phone_ <br />DESCRIPTION: <br />Lot _ <br />Block — <br />Division or Addi[ion <br />-- <br />— <br />- <br />Sewer District <br />_ <br />"horn, y Sewer <br />Monthly Sewer Constr. r <br />4pproved By—. t� <br />City Engineer <br />Issued <br />Connection By <br />G C <br />Inspection By D/ <br />/ <br />Date Inspected �f 7 <br />SEE SKETCH ATTACHED INSPECHON <br />