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CHART MO._ <br /> everett _ / / <br /> � _ /" °'� (�- :<< � '? 3'; <br /> r <br /> C.IL� Of EVB►BLl � <br /> Sewer Application and Permit <br /> N�. 26903 DATE ���r Z�, 19eo _ <br /> Service Address 6231 OaAv Ial. Utility Account No. I <br /> Billing Address 12b01 Sl�t Dr. D�t Permit Fee_10,.4Q_ I� <br /> City,State, 2ip M�zrrrvill�, MA 90270 Connection Chargels) Reo.00 , <br /> Owner (Mortgagor) Tia Twnau�n Total Fee �o.00 ' <br /> otllity n�rslcps�at Pee ord. 1171-85 <br /> Billing Name_ �� wtar 179.00 <br /> �oraz 171.00 <br /> ��nnection By � 650.00 <br /> Address 8�a� Signed <br /> ; �}tlPP!lfHB 1�S4FM qODAHl!'� tttt <br /> f'hone 659-7�2+ � <br /> flk�l:'U9:�(i <br /> DESCRIPTION: Sewer District_���Bnti��3.t+� _ I <br /> Lot g Block � ��87 _ �t[�i ti5.40 <br /> Monthly Sewer SenAlE7� �:'u'� <br /> Plet f1.N CH 443.H9 <br /> Unplatted Description _ Monthly Sewer Conitr,i,y;Fl f3.5C1 ' <br /> E t�Cll 115.(]0 I <br /> — — Trunk nw�+', nQ� in <br /> Typa Pennit: i�xlQ�by03 <br /> Lateral qu-� aoe�ee m <br /> t�t+ r cax�.ix� <br /> Remarks� <br /> Abutting I_ot Line1����� �ti�•� <br /> N g E yyIk1IM1I1bIh�L ft. <br /> hY1i[}' f750.(l0 <br /> IA�11kOF19 <br /> uarfr +r.��.c�u <br /> C11[Ll; i';59. `i; <br /> Approved By ar.��n n_ +ar.r <br /> Gry EnQineer <br /> IMPORTANTI <br /> Issued By � � a�•gw <br /> CALL tA00-424-fi65598•HOURS <br /> PRIOR TO DIGGING <br /> CALL 259s8N FOR INSPECTION I�!�� <br /> Inspection By <br /> Datelnspected 3"�3'jJ � <br /> SEE SKETCH ATTACHED N0. `��0� <br /> I�dCf'�Cl!�-`.�J � <br />