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„ ,, <br /> .— ,__: I _ <br /> yvere . �- . ! � M �'i :' ,M � - <br /> � <br /> � ' ._- ",� I _' � i .: � 'r. � <br /> \ <br /> Gry oi tverett I <br /> En�ineering Department <br /> Sewer Applicatio� and Permit <br /> rvo. �0548 . � 3353 <br /> DATE <br /> � 79/8 �u. �/�_. � ,0�. <br /> Service Address Utility Account No. ' - - <br /> Billing Address Connectiun Permit Fee <br /> City, State, Zip -- Connection Fee ” � <br /> Owner (Mortgagor) Total Fee — <br /> k " <br /> Billing Name <br /> Connection By %� <br /> Address � Signed <br /> . PhOne � . � Cusmmer <br /> ' DESCHIPTION: <br /> ' Lot <br /> � <br /> Block <br /> pivision or Addition - <br /> � Sewer District <br /> Remarks: , Monthly Sewer Service — ' <br /> — � , � ! , Monthly Sewcr Constr. <br /> � � <br /> Y" � <br /> � �� �' ,7%y � <br /> � Approved By � � � �y <br /> � <br /> — City Engineer <br /> �!' ` c. � - <br /> Issued By <br /> � Connection By <br /> ' Inspection By � ��-`�� <br /> Datelnspected_ ���`1�7'� <br /> � <br /> SEESKETCH ATTACHED <br /> INSPECTI��P: <br /> ..�_, <br />