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U <br />City of Everett <br />Enginceiing [lepartrnent <br />Sewer Application and Permit <br />NO. ?0970 DM <br />— — -- <br />Service Address___ __ <br />Utility Account No. <br />Billing Address __ -- <br />.-- Connection Permit Fee_ <br />City, State, Zip ____ _ _ .- <br />_ Connection Fee_ <br />Owner (Mortgagor)_ _ __ <br />Total Fee <br />Billing Name -- <br />Connection By_ <br />Address Signed <br />Customer <br />Phone — <br />DESCRIPTION: Sewer District <br />Lot <br />Monthly Sewer Service. <br />Block <br />Division or Addition ' 1'if r' T '/ — Monthly Sewer Constr. <br />11 <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By. I- <br />CaV Engmeer <br />Issued <br />> } <br />Inspection By — <br />Date Inspected <br />ND. 20978 <br />