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- -- --.--- �- .- <br />„ <br />`�: <br />� p �j <br />`� �SO �'_ _J o .� �J C� � <br />S� • � J • � • <br />.r t:l r� O n �i ..7 _ _ ? -n <br />� .A ' �� <br />�, b� M �-� � _ !. * C�. <br />p G �r . �..� .. „'. <br />Sewer Applicatio'� and-P��ni�t �. <br />� ,� : : ? � � , J � ; � � � � <br />f .. J � . .: 4 � 4-� .� <br />: L: <br />�9?0?_ rkDATE _ __l. / %_;/ , <br />Service Address �' 72 �"�'���� ��'� )��) Utiiity Account No. <br />7.37 EL`1 ST <br />Billing Address <br />Ciry, State, Zip <br />EVERETT MA 98'L03 permitFee $ <br />Owner seLFc•r xoneE Connection Charge <br />Connect��� h� � - Trunk <br />, . .. . <br />CHART NO. — <br />Address Lateral <br />Phone _ <br />Legal Description: <br />�ot <br />Block <br />Plat <br />Unplatted Description: <br />Type o( Permit <br />Remarks _ <br />}�pNABR00K DIV 3 <br />NE.' CONNECTIO\ <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />TQ POSTING�zi-43 <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />� �... <br />70.00 <br />, .a <br />$ no Qp <br />$ -- <br />$ 179.00 <br />Sewer Bond District C / �- � " <br />Abutting Lot Line <br />N�S,E,W ft. <br />Approved By <br />Issued By �' � <br />/', / <br />Customer Signature ��' �' `' � � `�"� ' r" <br />Inspection By � `�c°�ti u �� �I <br />Date Inspected y� �- y� �j <br />i <br />I� <br />INS°ECTION . � 13 �' ? �' <br />