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CHAiiT N0. <br /> everetl I <br /> e <br /> City of Everett <br /> Sewer Application and Permit <br /> No. 25335 DATE �r le, lsss <br /> Service Address 15�0 Mt Culn° �°b �al1��4 � Utility Account No. <br /> Billinp Address <br /> ili 12�fa lte�cK t.11. Permit Fee �'� <br /> City,Stete, Zip ��t, Ma. ft20� Connection Charge�s) <br /> Owner (Mortgeyor) <br /> MkMr rA Oa�p�w� Total Fee_��'� <br /> Billing Nernu — <br /> Connectfon By <br /> Address Signed � � ' � � <br /> �uttomer <br /> � <br /> Phone ��'u�� <br /> DESCRIPTION: Sewer District <br /> �and II1 <br /> Lot » Block Monthly Sewer Service �G� <br /> Plet 1�wclr Mrtn 'it�at� �2 <br /> Unplatted Descrfption__ Monthly Sewer Constr. <br /> Trunk <br /> Typa Permit: � �,pa <br /> Lateral <br /> Remarks: ���p 4 Abutting Lot Line <br /> N� g� E, yy ft. <br /> Approved By �� R� �� <br /> ciW enyineer <br /> IMPORTANTI Issued By �� � <br /> CALL 15.�'4T4�6666 48-HOURS <br /> PRIOR TO DIGGIN6 <br /> CALL 269�8811 FOR INSPECTION I � <br /> �Inspection By <br /> �Date Inspected <br /> SEE SKETCH ATTACHED N�,. ��335 <br /> I fdSP[CTION <br />