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CHART N0. W � "`'�t ' S <br /> everlll <br /> , � <br /> �� � � <br /> (Z����� y/�7�� <br /> Sewer Application and Pern�it _ . <br /> NO. Z33� DATE ���ll�— <br /> ���A�� Utility Account No. <br /> Billinq Add►essJl��' Permit Fee ���` <br /> City,State, 2ip Connection Chargels) <br /> !=r <br /> otal Fee � <br /> Owner (Mort r) � �— <br /> Billi�g Nam <br /> Connection By � <br /> �S� Signed � <br /> Address ' �-----�-- �f ust er <br /> Phone <br /> � S9- 9�qr � <br /> DESCRIPTION: Sewer District <br /> �ot — � B�o�� � Monthly Sewer Service <br /> Plat <br /> Unpla d Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line --, —� � ft. <br /> N, S, E, W ��� <br /> --_ APProved By ��� ' '� . _"�. <br /> City Enpmex <br /> Issued By ' � <br /> Inspection By � � � <br /> Date Inspected 3 �� ^�� <br /> SEE SKETCH ATTACHED N�� 23329 <br /> INSPECTION <br />