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I <br />everen ' <br />-. LS .. L. � i ; I� <br />I <br />� ",4 1:1 1980 <br />city ot Everen �. � 0; [�.'; ;� � Tr . <br />� � � :�t. <br />Sewer Application and Permit <br />No. 23529 <br />Service <br />Billing Address. <br />City, State, 2ip <br />3/17/BO <br />DATE <br />6706 A c n H�wrly Bl�d. <br />P.O. ias 19�7 <br />Ewtattr M�. 98]O6 <br />Danard CWta� tloM� Ino. <br />Owrer (Mortgagor) <br />D�nard Glutas tia�sn Ina. <br />Billing Name <br />CHART NO. �S - V `Y c <br />Utility Account No. 1f618-3 <br />]0.00 <br />Permit Fce <br />7� 572.50 <br />Connection Chargels) <br />30.00 <br />To[al Fee <br />D�aard C1t�tas tiae�� Inc. <br />Connection By — ,�� , j' <br />Address Signed_ � � / ' ` ���_�`� <br />customer <br />IS9-1001 <br />Phone — <br />S BoM I <br />DESCRIPTION: Sewe� District <br />Lot Block �Mbr�d <br />Monthly Sewer Service <br />Plat <br />Unplatted Description =iO� A-B.T. 1202-{1-79 Monthly Sewer Constr. <br />_ . 0.]0 7�OOt7I 107.50 <br />Type Permit: liwr Oos++ueCion <br />SEESKETCH ATTACHED <br />INSP[CTION <br />2.10 7/�i�Ot �GS.00 <br />Abutting Lot, l,ine <br />N, S( �J W <br />8. Marr�n <br />Approved By <br />Cny Enpinem <br />E. Bond <br />Issuej By <br />75' <br />� � <br />I nsp�!ction�. <br />Date Inspected �— 2-Z' �'U <br />N�. 23529 <br />