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everell <br />City of Events <br />Sewer App1"Kation and <br />,er -/ , CHART NO. _ <br />r 06-28-b <br />SFrA17Tit/G- <br />� <br />N0. 25573 -1L <br />DATE <br />Service Address Utility Account No <br />Billing Address 6E211 11111"1149 $tr <br />City, State, Zip i1letMtt MII M203 <br />Owner (Mortgagor) ho Schillaty <br />Billing Name 0, <br />Connection By Same <br />Address M - <br />Phone -Will -- <br />Permit <br />Connection Charge(s) <br />Total Fee <br />Special Sagwr fees Ord 1171-85 <br />Duples - Weir 261.00 <br />Sewr 608.00 <br />Signed <br />Customer / <br />DESCRIPTION: Sewer District _ <br />Loth_ Block <br />Monthly Sewer Service <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: ■ Trunk M.00Newen�eeetfen <br />Remarks: <br />Lateral it0 nn <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />IMPORTANTI <br />CALL 1S00424-555548-HOURS Issued By <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION LL <br />Inspection By� <br />Date Inspected 3 ` e , <br />SEE SKETCH ATTACHED NO. 25573 <br />INSPECTION <br />