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tvereft _ ,�3' CHART NO. � ' �-' -' S �`� <br /> � <br /> C <.. � - .: •� <br /> 17r� �-.:i's� �1 i.rt�.lL �r. /: � � <br /> � �J9 <br /> � r-; ;. cr"� �� � � _��.,•� Sh�r� <br /> . -o <br /> Gty of Erer�tt ,�c�e 3c+-� <br /> . . . 7� ;c �—` � <br /> Sewer Applieation and Permit <br /> � �•`�1� <br /> N0. Z6'.OZ . DATE U' -a0 , Y"� , � ^=C — cg� <br /> Service Address ' S�3 �O � ��l ' � � Utility Account No. _. <br /> '� <br /> Billing Address Permit Fee <br /> City,SWte,Zip Connection Charge(s) <br /> Owner (Mortgagor) Total Fee <br /> 8illing Name_. <br /> Connection By_ G �'�'.f �� FuQ.rei"'i" <br /> Address Signed <br /> cusron., <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot Biock <br /> Plat _ Monthly Sewer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Typa Permit: <br /> Trunk <br /> � ��1. Lateral <br /> Remartcs: 7( '� ��e�»-. r s T� <br /> � Abutting Lot Line <br /> ��o '. fJ M A� �! N, S, E, W ft. <br /> S.'S� Yor� o -f � . �. <br /> .� <br /> Q�����;�� d ro,� m �/ �r.�,,.d P�ae w. ''�L <br /> �-����. _ ���� y _ �-�«� - Approved By �,ry E�;,� <br /> IMPORTANTI <br /> CALL 1�800d24-5566 48-HOURS ISSued By <br /> PRIOR TO DIGGING <br /> CALL 259�8811 FOR INSPECTION /J <br /> Inspection B. �`G��' <br /> Date inspected /- a�— �7 <br /> SEE SKETCH ATTACHED . N0. Zs1OZ <br /> . UTILITYBILLING <br />