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everett <br />4' <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO.1 0 318,.vd-C DATE <br />gC+ 6 .s t -SW <br />Service Addr ss Utility Account No. <br />Billing Address Connection Permit I <br />City, State, Zip Connection Fie_ <br />Owner (Mortgagor) <br />Billing Name_ <br />Connection By_ <br />Address <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition C <br />I] <br />Total <br />Signed _ <br />Customer <br />SEE SKETCH ATTACHED <br />1re f'I-r-1iO!d <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Approved By <br />City Engineer <br />Issued By. <br />Connection By (� _ <br />Inspection By v--L'm = <br />Date Inspected j// 7/ ! 3 <br />