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i <br /> � evered CHART NO -z9�s <br /> I � �OS � �'� <br /> i �� _ . <br /> , � -' / 9' 7g <br /> City of I:veiatt <br /> � Engineering & .^.ommunity Services I �� <br /> I <br /> � Sewer Applico�;::r� and Permit � <br /> ; � <br /> N0. r.� r' i , : , DATE —!'�� � ) T --- — � <br /> Service Address � ` � ' � �.-"�-k-�--k- Utili;y Account No._.. <br /> � -- <br /> � Billing Address � :'' l ' � I�� '��-�� _ Permit Fee ��.I l' �L. <br /> City, State, 2ip �-- ` �-�< <-�i � J�_a L �-_ ( Connec:ion ChargP�s) <br /> Owner (Mortgagor) � ��„" �1`��. �_�'�=� -f% ,�-> Total Fce ��' �' '- <br /> ! P.illing Name n��' " T I� ��. �vC <'=.l�.v — ------ — -- <br /> I <br /> � ConnectionBy �� � `� �'F= �vt�-LLt"T' <br /> � - <br /> i Address _ Signed_ '� �� , l ', ------ - <br /> Customer <br /> Phane ____ <br /> i` <br /> i DESCRIPTION: Sewer District___ ___ <br /> � Lot - � '- - ' Block �'�-" ` <br /> IPlat���t-kt.�r �" Monthly5ewerService _ <br /> � Unplatted Description __ Monthly Sewer Constr. <br /> Type Permit: �i1-,;,� 4. <br /> Trunk <br /> i _ Lateral ___ <br /> � Remarks: � �n���� y�r ���, .S/ ''� � Abutting Lot Line <br /> ' __ �.t� o'� ��!! ,� .SL��-1 N, S, E, W _ft. <br /> � ,cic /� � --- <br /> i — - - <br /> { APProved By �- t �L.' ` - <br /> 1 _ Ciry Enginurr <br /> I <br /> j Issued By �_. l _ i `. I l__ { �l � ' `+� -- <br /> t <br /> � � <br /> I — - _ Inspection By �� �-+�.�"-''' _ _ _ _ <br /> I o --___ _ _ Date Inspected � " �3� __ _ <br /> � SEE SKETCH ATTACHED NO. <br /> � <br /> ,e� <br /> . .« � . _ _ c i. '. <br /> I <br />