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� <br /> �' , CHART NO. <br /> eve�� � � � � <br /> e �� <br /> ���'�` �.\y` ��' <br /> �C �, '��, <br /> , � , <br /> cn,, �r e�.�cc �,� , '� ,� <br /> „'�b° '�A <br /> Sewer Application and Permit � � <br /> NO. Z64O1 DATE '4 - �� S �'o <br /> Service Address 23 o U � u ( t U N Utility Account No. <br /> 8illi�g Address Permit Fee <br /> City,State, Zip_ Connection Charge�s) <br /> Owne► (Mortgagor) Total Fee <br /> Billinp Name <br /> Coonection By �- � �' v o F �. UG ke rt� <br /> Address Signed <br /> c�srom.. <br /> �fOfIQ <br /> DESCRIPTION: Sewer District <br /> Lot_T_ Block Monthly Sewer Service <br /> �n <br /> Unpl�tted Description Monthly Sewer Constr. <br /> Typa PKmit: Trunk_ <br /> QP,,,�li J 1� <br /> Laterel <br /> Remarks: � �'j � a g � m a � r.v <br /> � Abutting Lot Line <br /> Q o M/o r N, S, E, W n• <br /> f��(,J i r i o <br /> � R o nJ <br /> �A/til �I 6 !� �. TP a �.�. �] � (7 Approved By c�a e�u��.« <br /> IMPORTANTI S.S , @ �/�. �' /7 ���� BY �N Mi �le r <br /> CALL 1$00�24b65648-HOUHS� ! <br /> PRIOR TO DI(i01NG /03 S • O` M N <br /> CAL1268�811 FOR INSPECTION @ �3d• <br /> Inspection By <br /> Datelnspected y�� — <br /> SEE SKETCH ATTACHED N0. LV4O1 <br /> UTILITY BILLING <br />