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everetf <br />e <br />City of Everett <br />Sewer Application and Permit <br />26031 <br />N0. DATE _j....p•�IAA7 <br />Service Address 1720 70th Pl. S.E. <br />Billing Address pq_9ex 592 <br />City, State, zip---+4*"tt,yen9, MA-98258 <br />Owner (Mortgagor)_41,1,, A_Smith <br />Billing Name Sa"— <br />Connection By _ <br />Se+ue ----- <br />Address <br />Phone — <br />DESCRIPTION: <br />Lot 3 Block_ <br />Plat Colby Platt <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1.800A24-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART N <br />c� To l NARriaYr q/Z q/B 7 <br />8$QSi88 8 888 <br />w• •O .� M <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s)�7�� <br />Total Fee_30.00 <br />Special Utility Fees, Ord. 1171-85 <br />water119.00 <br />sewer471.00 <br />650.00 <br />Signed <br />Go,ome, <br />Sewer District Rn <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ ft. <br />Approved By <br />, <br />Issued By <br />Inspection By_ � :'' //lT� - <br />Date Inspected L-/F_v <br />INSPECTION <br />No. 26031 <br />