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CkART N0. <br /> everen ._�. f �� �'/e�;; :� /F- y-AE, <br /> e � <br /> � <br /> � <br /> c+er ot E�eran � 8 <br /> � � � <br /> � r <br /> Sewer Application and Permit � , � � <br /> � � � � <br /> ryo. 26919 DATE ee�= 2s �1sa '" <br /> Service Address . Utility Account No._. <br /> Permit Fee �0•� <br /> Billing Address <br /> City,State, Zip ��t� � ��� Connection Chargels) <br /> Ovme► IMor�yayu�i <br /> Total Fee �'� <br /> Billing Name "-' <br /> Connection By � �� � <br /> �,% { - _ l <br /> Addreas _ Signrd ���a��, <br /> Phone •"�•"a - <br /> $ewer District �a i* <br /> DESCRIPTION: <br /> Lot ^ Block Monthly Sewer Service ----- <br /> Pl�t <br /> Unplettod Dmcription Monthly SeN•er Constr. <br /> Trunk <br /> Typs Permit: � �etf�e� e! �sl�tLw 6�a� <br /> Laterel <br /> p�msrks: Abutting Lot Line <br /> N, S, E, W tt. <br /> Auproved BY <br /> ur ,w�o.e. <br /> IMPORTANTI Issued By +�-- -` - ""''�"' — <br /> CALl.1�800d24�6656�8•HOURS <br /> PRIOR TO D16aINO <br /> CALL 269�8811 FOR INSPECTION � <br /> Inspection B� <br /> _ � �� <br /> Date Inspected <br /> SEE SKETCH .4TTACHED <br /> No. 26919 <br /> IfJSPGClION <br /> :, . <br />