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r <br /> r <br /> � <br /> i <br /> evereft CHART N0. ` <br /> � e � <br /> � <br /> � <br /> c�cy o, e�e�an ! <br /> i <br /> Sewer Appiication and Permit � <br /> , <br /> � <br /> z4471 � <br /> NO. DATE _S�hrnnry 7$y l �qj r""' " ' ! C - -_ - - <br /> ,�J � i <br /> Service Address�3 GhestilYt Utility Account No. <br /> � <br /> Billiny Address Permit Fee�__ I <br /> City, State, Zip_ Connection Chargels) ! <br /> Owner (Mortgagor) Total Fce npnQ � <br /> Billing Name j <br /> iConnection By r��tv�nf Fygr�i�_ _ � <br /> Address Signed_ Doa A(i11cT — I <br /> c�„�om�� — � <br /> Phone � <br /> -- -- p I <br /> DESCRIPTION: Sewer District I <br /> Lot Block <br /> Plat Monthly Sewer Service__ _ j <br /> Unplatted Description _ ._ Monthly Sewer Constr, <br /> -- Trunk <br /> Type PermiL �epe#T I <br /> I Lateral_ I <br /> Remarks: , y� � �� �� , . <br /> .c. , <br /> � Abutting Lot Line j <br /> - r '�i ii- t �'� �/ .//, /•/ I N, g, E, yy <br /> ft. <br /> I <br /> jApproved By ! <br /> � cnv ea;r <br /> — I <br /> Issued By � <br /> , 1( i% �,r . ' � r ,�-- ; <br /> F/y i <br /> Inspection By � I <br />' — _ Datelnspected - ' I <br /> i <br /> SEE SKETCH ATTACHED N� 2441 1 <br /> �NSPEri��N � <br />