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ever At <br />/ tr <br />City of Evere.t /� t <br />Engineering Department <br />Sewer Application and Permit <br />NO. O O 16 DATE <br />Service Address _ <br />Utility Account No— <br />B;Iling Address. Connection Permit Fee - <br />City, State, Zip _. Connection Fee <br />Owner (Mortgagor) Total Fee <br />Billing Name <br />Connection By_ ; <br />Address Ol it/c�%^.c "rCG:•% Signed <br />Customer <br />Phone <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Mo <br />Sewer District <br />Monthly Sewer Service <br />nthly Sewer Constr <br />Remarks: <br />c6 "o � L, <br />Cun=l '76 Ap <br />Issi <br />Co <br />- — Ins <br />— -- - Dal <br />SEE SKETCH ATTACHED INSPECTION <br />proved By <br />City Engineer <br />red By, <br />❑nection By /n� <br />pection By Nw""'°� <br />e Inspected z <br />SEE SKETCH ATTACHED INSPECTION <br />proved By <br />City Engineer <br />red By, <br />❑nection By /n� <br />pection By Nw""'°� <br />e Inspected z <br />