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� <br /> �a <br /> �' - - — _ <br /> l �'°���`i 5 /;�o�l,,./� 3�Z�js "� <br /> r.ir., �f E:��:c;; " � <br /> --� <br /> Engineering Department <br /> Sewer Application and Permit <br /> N0. C�0776 DATE -. _ .''`- 337� � <br /> _ - . <br /> Service Address �- � � - ,` - Utility Account No. <br /> Billing Address Connection Permit Fee <br /> Ciry, 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 /> Lat - <br /> Black Monthly Sewer Service <br /> Division or Addition ' /` Monthly Sewer Constr. <br /> 1 <br /> ' Trunk <br /> Type Permit: • <br /> Lateral <br /> Remarks: <br /> ' r '1�' <br /> Abutting Lot Line <br /> �e,,� - N, S, E, W_ - ft. <br /> L � / ' �. <br /> _.,7�,e� . �?�L � ' �• � <br /> ��7�.�4L�2 Tes . :J 5 .� �.f •l� <br /> Approved By . ' �;! + ' :-_ <br /> Ciry Engineer <br /> d / <br /> S . O <br /> Issued By <br /> Inspection By �"��� <br /> IDate I nspected <br /> 0 <br /> SEE SKETCH ATTACHED NO. � (� 7 ( l� <br /> INSP[CTION <br />