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everen <br />e <br />City of Ewrett <br />Sewer Appl'Kation and Permit <br />CHART <br />�..� �,,cti��,.���r iz�,.-eg <br />NO. �v�v` DATE �lhly 14, 19lE � <br />Savice qddress �n+t �,�'��a �y Utility Account No. <br />Billiny Add►ess a.r Permit Fee_ _ �p <br />City, Stete, Zip- �t, q �p0. <br />Ownx (Mortgagor) � ��-- � <br />Billinp Name ..�. <br />Connection By- � <br />Address ..�� <br />�1011Q �i� ���i <br />DESCRIPTION: <br />lot <br />Pl�t <br />Bicek <br />Connection Charge�s) <br />Total Fee ��p <br />Sig�ed <br />cwtome. <br />Sewer <br />Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />07!tq/BB 1:24fYf fi00RIfiM90 i#t <br />Trunk � <br />Typs Permit: pt! k7pOl�67S2 <br />� Lateral scucrr sa_sn <br />R.muks: � � „ ..� ra5t1 s�.5o <br />� M, <br />N/ � <br />� � <br />IMPORTANTI <br />CALL 1�800�424�6556 48•HOURS <br />PRIOR TO DIGGING <br />CALL 269-6811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />in <br />Issued By <br />Inspection <br />Date I <br />INSP[CTION <br />NO. �v762 <br />