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:-�. <br /> �� • ( ' • <br /> Ievere,tt _ /G — Z � ' /1� <br /> � � T <br /> / - z � � � <br /> CiY� of E.erect <br /> Engineering Department <br /> Sewer Application and Permit <br /> `Y <br /> � �� .� 3 � � <br /> ,, <br /> No. 2G651 DATE ` <br /> Service Address � � Utility Account No. - ` � '- <br /> Billing Address Connection Permit Fee �- <br /> City,State, Zip� � Connection Fee ' <br /> Owner (Mortgagor) '• Total Fee � � <br /> Billing Name <br /> Connection By <br /> Address Signed <br /> Customer -" <br /> Phone " <br /> DESCRIPTION: Sewer District <br /> Lot <br /> Block Monthly Sewer Service <br /> Division or Addition Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Laterai <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By ' <br /> City Enginacr <br /> Issued By <br /> i <br /> Inspection By �J =Zuc.,.J <br /> _ Date Inspected _�30�7 y <br /> a <br /> SEE SKETCH ATTACHED N0. '� ,(� (� 5 _1 <br /> Ii�ISPCiI Ilt)i! <br /> -+c_ <br />