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evereri <br />e <br />City of Everott <br />Sewer Application and Permit <br />CHART <br />T 3�-29-4 <br />�iE.u� To C./qzTi.c�G <br />S-i`�/-$7 <br />No. 25921 DATE Mtolwr 20.._]�� � <br />Service Address 4904 Ha�bo� Lane Utility Account No. <br />eilling Address 1710 - 100th M. Sf <br />City, State, Zip E�erett MA 9II204 <br />Owner (Mortgagor) JeN G�nente�" <br />eilling Name JanllS G�f}ner COnstru�tlon <br />Connection By 6affnlv <br />Address <br />Phone 338-211! <br />DESCRIPT�ON: <br />Lot �n�,PpFg� Block <br />Permit Fee 30 0'I <br />Connection Chargels) ����'�Q 001:dNi'ii QiICMa!):5.�: 1t1�# <br />Total Fee + b1704a <br />Sueclal Ut111ty ' Ord ��. -85 <br />Meter 2 y � s3�.:'iU <br />SQMei xi.�,� <br />i�15.1Y1 <br />Signed <br />INi�MJ'i ?iY1.1f0 <br />� � .�.: <br />uii1FT �w50.pp <br />R{N�3:39�1 <br />Sewer District ���}� e- •g�u� <br />—� .l t <br />Monthly Sewer Serv���l-5 iE31'.iU <br />Plat ld1E l 51 6i.�U <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1�600-424•5555 46-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSF'ECT�ON <br />SEE SKETCH ATTACHED <br />Trunk +�n �� <br />--�_ . <br />Lateral <br />Abut[ing Lot Line <br />N, S, E, W ft. <br />Approved By � re�� <br />City EnDineer " � <br />Issued By ���,r-,�-p�y <br />Inspection B �� t'���-- <br />j-�.? - .l-- -7 <br />Date Inspected / <br />INS?GCTION <br />Ne. '25921 <br />