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� <br /> I ' <br /> everetl CHART NOZ�17•�� S <br /> � ��//Si�.c� : <br /> city of Everen �" '� '�f <br /> Engineering & Community Services �� , <br /> Sewer Application and Permit <br /> N0. ;� j' f� L �_ DATE ��' '• �7 `� <br /> � � <br /> ServiceAddress �/� ^' -� / �f. ;-f, f.i <br /> -� Uttlity Account No. I <br /> 1 <br /> Billing Address �^T '�` � /•� � ` �> • Permit Fee �� -•' <br /> - ��y G�'. _��' Y .� J .� <br /> City, State, Zip -� _____, % �� '%1')�' (Eonnection Charge�s) <br /> Owner �Mortgagor) � f �/ �" • � ` . • Total Fee 7�� � <br /> Billing Name <br /> � <br /> Connection By � <br /> ,, / i <br /> Address Signed ' '/l�> � " .� `/!/ <br /> Phone_ �� �/��yG c""°"'°` <br /> DESCRIPTION: <br /> Lot .-'� - = Sewer District <br /> Block�'`t <br /> , Plat ' ' � ;% r; •�/_ Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. '' <br /> Type Permit: :�i� , � , Trunk + <br /> - , <br /> , � — <br /> ' i._ Laterol <br /> Remarks: ' `1 <br /> Abutting Lot Line ^� j / <br /> N, S, E, W /�r��= /� . � ft. <br /> _�- ' <br /> APProved By_ ,�fl/-' ` <br /> Gry Enpmeer <br /> 0 / ,..,, j'� <br /> Issued 8y r _ �,� � ' <br /> — I nspection � <br /> p — -- _ Date Inspected��-�,P � <br /> SEE SKETCH ATTACHED NO. <br /> if i � � ii, , , � f <br />