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i � <br /> evereft - <br /> e � . _ �� <br /> , 1 ' � �.rlJ ;. � .l� <br /> FY <br /> City of Evere;t <br /> Engineering Oepartment <br /> Sewer Application and Permit ,� � v 2� <br /> N0. .'�O 2 � / DATE _ � — � <br /> C��l �iq c� f r L <br /> , <br /> Service Address � Utility Account No. <br /> Billing Address Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (Mortyagor) . To.al Fee <br /> Billing Name <br /> Connection By <br /> Address ' Signed <br /> . ' Cuslomer' � <br /> Phone �� � <br /> DESCRIPTION: <br /> Lot <br /> Block <br /> Division or Addition � <br /> Sewer District <br /> —' — Monthly Sewer Service_ � " � <br /> Remarks: • ., , ' � . , / <br /> � � /J� / Mcnthly Sewer Constr._ 7����7G <br /> ,9 TG /� S�.(/ <br /> ,� <br /> ( 4a.�..u���,v s�.� c,��.�'..,Q.t�-�� S` .2-�-8-� � �1�ci o� /�PProvedBy ," <br /> Ciry Engineer <br /> G��Gt�^^.n�,�w.�._.. . ' �� $ W " � l� Issued By ' _ � <br /> ,� . �`� -- <br /> �`'�'� W ` Connection By ___ <br /> �S�-_d' ,` Bw.�i — <br /> Inspection By /.���L�--^� .� <br /> __ Date I nspected_ "i'�_?��s__ _ <br /> — � <br /> :8I <br /> SEE SKETCH ATTACHED <br /> t : <br />