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CHART N0. <br /> everetl V�,-f ;��, C/�c�/.�� �Z-ib-es <br /> e <br /> II crty a, e�e.an <br /> Sewer Applicetion and Permit <br /> N0. LVV�� DATE 6�ptaber 30. 19es — <br /> Service Address Utility Account No. <br /> Billing Address. ���+� +�� ' ,� � Permit Fee � tn <br /> City,State, Zip Con�ection Chargels)_ <br /> Owner IMortgagor) Total Fee ? sn <br /> Billing Name - - <br /> Connection By g--- <br /> l.— ' <br /> Signed _ /% �t' <br /> Address � ►- /, c�::o�� �/ <br /> Pfione <br /> DESCRIPTIQN: Sewer Cistrict <br /> Lot =�'� Block ��— Monthly Sewer Service <br /> Plat sl.c et a,�r��r pts � <br /> Monthly Sewer Co�4r��� `°�� ��u`� ��r <br /> U�platted Description / <br /> Trunk '��`�71 <br /> Typa Permit: pip o!t t�40 • <br /> Lateral <br /> Remerks: �Z� . <br /> � a�, — Abutting Lot Line�R S2.i0 <br /> �., • N, S, E, W ft. <br /> o u �u fI &1?q� l3.� <br /> 4NltM).°C�'62 <br /> � �{ sS.5Q <br /> q0011J.G873 <br /> Approved By <br /> , me 418.Q0 <br /> IMPORTANT! Issued Sy <br /> CAIL 1�OOd24b555 48•HOURS <br /> PRIOR TO UIGGII�G <br /> CALL 259�K817 FOR INSPECTION <br /> Inspection By <br /> Datel�spected — <br /> SEE SKETCH ATTACHED No. 26873 <br /> INSP[C'T10N <br />