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everen <br /> e � � ��� <br /> � . � <br /> c�ri ar e�erett <br /> Enpineerinp Department , . <br /> Sewer Application and Permit � <br /> � <br /> n <br /> NO. r. .l ��� l �i DATE � <br /> Service Address � �/��6adr�,eb� Utility Account No. II <br /> Billing Address _ Connection Permit Fee <br /> City, State, Zip Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection Dy_ <br /> Address Signed <br /> cmtomer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot���c_y..aC_ <br /> Block_ '� Monthly Sewer Service <br /> � .)/ ;��:—/ 1' ',' � , <br /> ; <br /> Division or Addition �� ----- -------=— — --- — Monthly Sewer Constr. <br />� Type Permit: — Trunk <br /> I Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> -- r . <br /> ,. <br /> `, <br /> Approved By <br /> City EnOinen � <br /> Issued By _ <br /> Inspection By <br /> Date I nspected <br /> a - <br /> SEE SKETCH ATTACHED NO. � 1_ (�j j 4 <br /> i � , <br />� <br />