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everett <br /> City of Everett <br /> Engineering Department <br /> Sewer Application and Permit <br /> , . , - ,/� , 33S f <br /> NO. lU6 � L <br /> DATE <br /> Service Address _ Utility Account No. 3n 71 3 1O v <br /> Billing Address /'biI _ _ Connection Permit Fee <br /> , Zip 8 -0 / <br /> City <br /> , StateConnection Fee <br /> Owner (Mortgagor) _'-_^ Total Fee <br /> Billing Name 1'illi <br /> Connection By 1 <br /> Address - �' (' /T ./ _ Signed <br /> customer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block .r Monthly Sewer Service <br /> Division or Addition�u%� /�/� %`r '-� /.' Monthly Sewer Constr. <br /> Type Permit: <br /> —� Trunk 2. y <br /> i"/ <br /> Lateral Z <br /> Remarks: <br /> Abuttin Lot Line <br /> �V S, E, W—J-i'—O AW .'7- ft. <br /> T-Ronr9 � <br /> Approved By <br /> City Engineer <br /> Issued By. <br /> Inspection Byea-x_j ze <br /> Date Inspected d-Z/- <br /> a <br /> SEE SKETCH ATTACHED NO. <br />