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CHART N0. <br /> everett <br /> e <br /> City of Ewrett <br /> Sewer Application and Permit <br /> No. 25233 DATE //�" �/ �5 <br /> Service Address �y /a Utility Account No. <br /> Biliing Address <br /> � p � � Permit Fee gZ ��""' <br /> City,State., Zip �/ Connectio�i Charge(s) <br /> Owner (Mortgagor� _ Totai Fee ,� �— <br /> Eilling Name <br /> Connection By �— <br /> Address ��L�,� Signed <br /> Cu�romer <br /> Phone ��s �" - 1, 97� — <br /> DESCRIPTION� Sewer District <br /> Lat� Blo Monthly Sewer Service <br /> Plat ; �� �� <br /> :Inplatted Description Monthly Sewer Constr. <br /> _ Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> ' R1 S E yy ft. <br /> Approved By "� " �'r � � — <br /> ciry Engineer <br /> Issued By � � �" <br /> Inspection�F�j+...�� <br /> Date Inspected �'y—�r <br /> SEE SKETCH F�TTACHED NO• Z5233 <br /> ItJSPECT ICtJ <br />