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1 <br /> � CHART N0. I <br /> everelt ' <br /> � P���".� <br /> City of Eventt -�. �, � � <br /> �� <br /> � <br /> Sewer Application and Permit �� `' <br /> N�. G4371 DATE /d�1l� � <br /> Service Address��!y� Utility Account No. <br /> Billing Address / y++'d ����� Permit Fee '/7G <br /> City, State, Zip (�U �� �"�+ .���d� Connection Chargels) <br /> �_' � ---� <br /> Owner (Mortgagor) � Total Fee d <br /> Billing Name <br /> Connection By <br /> Address Signed � <br /> customer <br /> Phone �S9' yS3� <br /> DESCRIPTION: Sewer District_. <br /> Lot��a � Block��y Monthly Sewer Service <br /> Plat �i��- ,��4�-' � �i'+c/ C,CdF4'� <br /> Unpletted Description Monthly Sewer Constr. <br /> _ Trunk <br /> Type Permit: . <br /> Lateral <br /> Remark • Abutting Lot Line <br /> _ +� N S E W �� ,'�-.... ../ ft. <br /> Approved By ��� �� � � <br /> Clry Enyinear� <br /> ISSUEfI BY ' Y .� / <br /> Inspection By � I --.1 <br /> Date Inspected <br /> SEE SKETCH ATTACHED N�• �4371 <br /> i {NSPECTION <br /> �-� _ � <br />