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p�;raper.�r�•.'R itRT.''.t''�4,`�?���L'�6..h:�LT.�,:�•.� t.6 v,.v�r.:e,?7Ar..ci,r r,.,,i1ti�".ASk�,�+�'. <br /> CHART NO. <br /> eLr ,t <br /> ssssss s sssTO M!TWs <br /> N <br /> Sewer Application, ndMPr <br /> 2 9 1 1.6 DATE <br /> Service Address 2501 57th Bt 6N <br /> Utility Account No. --- <br /> Billing Address 14410 841-ked Rd <br /> City,State,Zip Bellevue MA 98007 Permit Fee S _ 70.00 <br /> Owner ••//.v.,.,e ru+••• Connection Charge <br /> � <br /> Connection by .4", i,T Trunk 5 <br /> Address Lateral $ <br /> 0.00 <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water E 224.00 <br /> Lot ___ 50 Sewer $ <br /> Block Total Development Fee E 224.00 <br /> Plat Pwder Hill llighlend• <br /> Unplatled Description: Sewer Bond District <br /> Abutting Lot Line <br /> _ _— N,S, E,W h. <br /> Type of nermii --_:ev coun,e t icn_ Approved Py <br /> Remarks ____.-- Issued By gb <br /> Cuslomer Signature ' �- <br /> IMPORTANTI <br /> CALL 1-800-424.5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259.8810 FOR INSPECTION Dat Inspection <br /> By <br /> lnspoci ���/�+4^ <br /> ed <br /> SEE SKETCH ATTACHED <br /> INSPECTION I •'. 29186 <br />