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everen <br />� <br />i�.ILY Oi EVQrQLi <br />Engineering Oepartment <br />Sewer Appli�ation and Permit <br />N0. _ . l ;l'� DATE <br />i <br />Service Address �i0 ."�.5 / V Utility Account No. <br />Billing Address <br />City, State, Zip _ <br />Owner (Mortgagor� - <br />Billing Name <br />Connection By <br />Address _ <br />`/�O ; x % �T� <br />Connection Permit Fee <br />Connection <br />Total <br />Signed <br />Customer <br />DESCRIPTInN: Sewer District <br />Lot /d <br />Block_ Monthly Sewer Service <br />Division or Addition �(��� ,F}�/� �7� Monthly Sewer Constr. <br />Type Permit: <br />SEE SKETCH ATTACHED <br />IIJSPLCTIf1iJ <br />Latera <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />Cily EnOineer <br />fssued <br />Inspectian By �° �f/tt�^✓ <br />Datelnspected 3�7/7 7 <br />NO. ��.I.�,j� <br />- 1, <br />