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everett <br />� <br />City of Everett <br />CHART NO. <br />�,,,�,% C�iu.�r� �-�9-8s <br />Sewer Appliccotion and Permit <br />N0. 2675a DATE <br />Service Address 93S 11]tL Bt• SS _ Utility Accou�t <br />Billing Address � <br />City, State, 2iP �t�tt, MA 961W <br />pwner (Mortgagor) <br />Billinq Name — <br />Co�nection By <br />Address <br />Phone — <br />DESCRIPTION: <br />Lot Block <br />Plat — <br />Permit Fee <br />Connection Chargels) <br />Total Fee - <br />gpE�y t1TIytT! !L6 plm. 1171-85 <br />�war �11.00 <br />Siqned cw�o�� <br />Sewer Oistrict e`� u= <br />Monthly Sewer <br />Unpletted Description Monthly Sewer Constr. <br />�;;;1)li/!�J ::`�1'�H 1If10AN1h0(1 11kt <br />Trunk / 370.G0 <br />Typa PermiC t;(nJU.'�STr� <br />Lateral `�.�F' �w.00 <br />liWlll f130.U0 <br />Remarks: Abutting Lot Line��'� �' ��71'� <br />N 8 E WU2�:L tH31.110 ft. <br />IMPORTANTI <br />CALL 1�800324-6555 48•HUURS <br />PRIOR TO OI(iCING <br />CALL 259$811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Approved BY ��p R' ��' <br />cnv E�pmeer <br />Issued BY e�7 a���n <br />Inspection By / <br />Datelnspected <br />No. 26754 <br />INSPCCTION <br />