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evereft <br />e <br />c�:,� us E�erecc <br />Sewer Applicotion and Permit <br />N0. 23492 DATE �n��� <br />Service Address ���� �U� <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection Bv ah' of E�r�tt <br />Phone <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Descriotion_ <br />Type Permit: r�pair <br />CHAflT NO.—� zD-z�-S- <br />Utility Account No._ <br />Permit Fee AOf1° <br />Connection Charge�s�_ <br />Total Fee � <br />Doa Niller <br />Signed <br />a�:��R��� <br />Sev.�er District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />SEESKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Lot Line <br />,S,E,W <br />H. harren <br />By <br />Gry Engmrer <br />E. fiond <br />BY-- " . -- <br />cted - i/- 'r/ <br />rvo. 23492 <br />