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� CHART N0. <br /> !V!r!H <br /> e <br /> City of Evmatt <br /> Sewer Applicotian and Permit <br /> No. 25332 DATE �_ }.e• �� <br /> �sm ...t �..,.o ...e ,�,. �� <br /> Service Address ._ Utility Account No. <br /> Billing Address <br /> 676 12� �![Mt i.11. Permit Fee �•� <br /> �wmt' 11�' fB2a Connection Char (s) <br /> City,State, Zip � <br /> Owner (Mortgagor) ���~ � �Y Total Fee_ �'� <br /> Billinp Name �� � d0�°� <br /> Connection By ___ ; <br /> Si ned � � -.�'�'; �%�_--�" <br /> Address 9 c�s�o�� <br /> Phone 3�7-11f� <br /> DESCRIPTION: Sewer District_ �� i== <br /> 7! <br /> Plat ��ir ~m C�� �� Monthly Sewer Service ��� <br /> Unplatted 6escription Monthly Se�ver Constr. <br /> Trunk <br /> Type Permit: 1Mr CaaMotiau <br /> Lateral <br /> Remerks: �ldiaq 1 <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> — Approved By �• R. T�al <br /> clty enOmeer <br /> IMPORTANTI ■, seaA <br /> Issued By <br /> CALL 1�800d24•6566 48-HOURS <br /> PRIOR TO DIQ6ING <br /> CALL 259�8811 FOR INSPECTION <br /> . <br /> Inspection By <br /> Date Inspected _�_�'XY � <br /> ��£ SKETCH ATTACHED No. 25332 <br /> IfJ;PGCTION <br />