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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />��o. 25194 DATE �IuLy �Q 10�� <br />Service Address 4319 S. 4tti Avc <br />Billing Address 4319 S 4th nve - <br />City, State, Zip Everett MA 98203 <br />Owner (Mortgagor) T� Sheflo <br />Billing Name <br />Connection By <br />Same <br />Phone 252-2514 <br />DESCRIPTION: 5 <br />Lot�a �_r a,�., Y� �lock-0g7-�-9g-- <br />Plat <br />Unplatted Description — <br />r..__ �.._._:.. <br />Utility Account No. <br />Permit Fee S10 00 <br />Connection Chargels) — <br />Total Fee_ S10 00 <br />Signed <br />Cus:Omcr <br />Sewer District <br />Monthly Sewer Service_ <br />_ Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTIOId <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By n� R i R mti i - <br />Ciry Enginecr <br />Issued By t4axasret Mf,S�od <br />Inspectiony�"'���"'�" - <br />Date I nspecred /� ' ��' � �� <br />No. 25194 <br />