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f � ,� � evereri <br /> � --� , O G ` ) �_' <br /> City of Eve�..n - - � <br /> Engineering Oepartment � <br /> Sewer Application and P�rmit <br /> 32715 <br /> N0. �.�..� �' _L �i % DATE _ <br /> Servicc Address Utility Account No. �- <br /> Billing Address Connection Permit Fee �— <br /> / <br /> City, State, Zip " Connection Fee <br /> Owner (Mortgagor) Total Fee <br /> 8illing Name " <br /> Connection By_ , <br /> Address � ." Signed , �-r�-�' : .- <br /> cu:�omer <br /> Phone <br /> DESCRIPTION: <br /> Lot_ <br /> Block_ <br /> Division or Addition <br /> Sewer District <br /> Monthly Sewer Service � <br /> Remarks � :'�f�' . /� � � <br /> Monthly Sewer Constr. <br /> c.�]�:E/L�(.� � � S <br /> � . ! <br /> Approved By • �`'" � <br /> L�I� ` �' _ / Ciry Engineer <br /> Q' <br /> Issued By ` <br /> Connection By <br /> � Inspection By �����"��`'��`�� <br /> / <br /> Datelnspected����3 � <br /> �, <br /> SEE SKETCH ATTACHED <br /> It9SPECTIOiJ <br /> . <br />