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i <br /> CHART NO. <br /> evtren I <br /> e <br /> r. <br /> c�ri ot e�� ;;� <br /> f,' ' `. <br /> , <br /> Sewer Application and Permit i ' ���'/ '��� � <br /> , <br /> No. � �9� 9 DATE 2 - 1 - 9 O <br /> 2/ 25 <br /> Service Address � ��d A V �— Utility Account No. <br /> Billing Address Permit Fee <br /> City,State, Zip _ Connection Charge�s) <br /> Owner (Mortgagor) Total Fee <br /> Billing Neme <br /> Connection ey C � {-•� o� �Ue Y _�"C <br /> Address Signed_ <br /> cu:romer <br />:J� <br /> 'i Pfione I �� <br /> � <br /> DESCRIPTION: Sewer District ; ' <br /> �4 <br /> Lot Block � �_� <br /> Plat Monthly Sewer Service I ± <br /> Unpletted Descriptf n Monthly Sewer Co�str. + <br /> Typa Permit: Trunk � <br />� Lateral � <br /> Remarks: �! <br />~. ��`�`--'�- Abutting Lot Line <br />',��-> �. � �' �.rM_ '� �v N, S, E, W ft. I <br />�'. � �, � <br />�, <br /> F, �n �'. S' . � �- � a <br />�� � , <br /> Approved By <br /> Ciry Enqmax <br />� IMPORTANTI <br /> Issued By 17�N �V� i l 1 e r <br />�,'< CALL 1$00�24-6666 48•HOURS <br /> C "� PRIOR TO DIa01N0 � <br /> � <br /> CALL 269�8811 FOR INSPECTION ,G <br /> Inspection By �--t•'- � (/= ! <br /> I � / <br />" Date Inspected � � 4 __ <br />' SEE SKETCH ATTACHED No. 2 6 y 8 �3 <br /> � <br /> CUSTOM[R COPY <br />