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everen <br />� <br />City of Evere <br />Sewer <br />� <br />tt ��� �Y� �z � aQ <br />� _,:.o — _�r; <br />- ., -.. - �:r � ' .-c <br />a... — .a .� -s C� <br />r. � ` -} <br />�ppb�qtiQn �and �Qe�mi� " � � �. <br />. r ...i � 4 - , f; � n - � �1 <br />,':� ��n:z :� 4r�j`.. � � �`f.�t-� <br />2l229 � ..z.:�..,:-�__-:�. _- -�:- -�:<�. <br />N0. DA7E . � ,. �e 21, 1909` <br />Service Address 3»��y��� <br />Billing Address — <br />City, State, Zip <br />OHmer (Mortgagor) �a xelaon <br />Billi�g Name <br />Connection By <br />Phone <br />DESGRIPTION: <br />Lot 27-28 Block 769 <br />CHART NO <br />L� _i" <br />� � � ' ' <br />;��.._ <br />Utility Account No. <br />Permit Fee 2.50 <br />Connection Chargels) <br />Total Fee 2.50 <br />Signed <br />Cus�omer <br />Sewer D <br />Monthly Sewer <br />Plat V.y�.±�r <br />Unplatted Description_ Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />� <br />0 <br />IMPORTANTI <br />CA L L 1-800-024-5555 48•HOU RS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCIi ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By �T.PRRD R_ THE�L <br />Ciry Engineer <br />Inspection <br />Date I <br />Ii 1: r6Cll�ii�! <br />No. 27229 <br />