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evereft <br />e <br />City of Evereri <br />Sewer Application and Permit <br />No. 23469 <br />DATE I- r�.� - r� D <br />Service Addressp�!1�3 �4 � �i�����G/ <br />Billing <br />City, S <br />Owner <br />Billing <br />Conne< <br />Phone��- Q �G � <br />DESCRIPTI <br />Lot Block <br />Plat <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />, 1 �, _ y <br />CHART NO.�. _ <br />P�TE,� <br />7 -Z8-8o <br />.Utility Account No. �%O -� <br />Permit Fee J°'�J <br />Connection Chargels�__�( i � �` <br />Total Fee_ <br />�D✓ <br />Signed_ <br />Cuslomer <br />SEESKETCH ATTACHED <br />INSPECT101d <br />Sewer District �% �� -- <br />Monthly Sewer Service�_�?�Y����— <br />Monthly Sewer Constr. <br />...18--- <br />Trunk ��� �`/�� _ <br />Lateral <br />Abutting Line L, <br />,E,yy T� ft. <br />Approved By /'1' - � <br />� Cny npmeer <br />Issued By���— <br />Inspection B�� - -�- <br />Date Inspected_ �G" �- �L� � `� <br />N�� 23469 <br />