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everen <br />� <br />city ot Evnren <br />Sewer AQplication and Permit <br />No. ''2,3629 <br />DATE I��`7_`-- <br />Service Address�� 2 ��a'i,SfF/�?�= AU.� <br />Bi!lina Address P' "` �" `r-�- <br />t��nJw oat.> <br />City, .itate, Zip ---""�— �w � `J� 3v � <br />Owr er (Mortgagor) y^ " � '�Q�' �� -' S.. c . <br />Billing Name�� <br />Connection <br />Address_ . - <br />Phone_ 7 7�� a� �` <br />DESCRIPTION: ��/ <br />Lot �-h�% Block_� <br />Plat��� /LC��T A�✓ l�"Z_ <br />Unplatted Desc�ption <br />Tvoe Permit: <br />CHART NO.� � ��T � ' <br />(�,St�V 7 - 21-�A <br />Utiliry Account No. <br />Permit Fee <br />Connection Chargel <br />Total Fee <br />�� <br />S'� <br />5'�' <br />Signed _ ` <br />cu:�ortror <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District -- <br />Monthly Se�ver ;ervice _ <br />Monthly Sew:r Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By — <br />Gty Enpineer <br />Issued By �� � "//'�l <br />Inspection B "'-- — <br />Datelnspected— / - l�� " ��� - <br />Na� 23629 <br />