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everett <br />� <br />� City oi Everett <br />Sewer Application a�d Permit <br />t�: <br />i ' '' '' <br />NO. 2$'19 Z DATE wy 14 . 1791,..___ <br />Service Address s�7 �e3ra e1 sak <br />Billing Address s� -- <br />City, StetB, Zip ��tt MA 99108 _ <br />Owner wc�,.�l e a mna� t Nilliw <br />Connection by <br />Address . <br />Phone _ �S5—Otil7 — <br />Legal Description: <br />Lo� w <br />Block <br />Plat olite 1►dditlm <br />Unpletted Dascription: <br />Typ60iP8fRllt Wr mnnwctloe� �=1Yi1n0 buil �Afne <br />Remarks .... ++.. ___ __ <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOIIRS <br />PRIOR TO DIGGING <br />CALL 259•88�0 FOR INSPEGTION <br />SEE SKETCH ATTACHED <br />Utlliry Account No. <br />CHARI NO. <br />Se.,+ � pash.�y <o-[�--q i <br />ParmitFee $ _ �0.00 <br />Connection Charge <br />Trunk <br />Lateral <br />Totel Connection Charge <br />Utility Deveh>pmr,nt Fee <br />Water <br />Sewer <br />Total Development fee <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />Sewer Bond District — <br />Abutting Lot Line <br />N, S, E, Ni ft. <br />Approved By _ ���,.�� ��2�oQ_ <br />Issued By — <br />Customer Slgnature <br />Inspectlon By � 6� ��u'���� <br />/ i <br />Date Inspected �` � ____ <br />IfJ: �f'I _C110N <br />NO. LPZaZ <br />� <br />