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eti� ett 1� -- <br />_S _ <br />C fE <br />i <br />ity o verett , <br />Enpneerinp Dep�rtment 4, <br />�, <br />Sewer Application and Permit <br />rv o. 2 p g 1� DATE <br />_ <br />Service Addren "� I '� . ' ' <br />Billing Address _ <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTION: <br />l.ot <br />Block <br />Division or Addition <br />Type Permit: <br />Utility Account No. <br />Connection Permit Fee <br />Connectian Fee <br />Total Fee_ <br />Signed <br />Customer <br />SEE SKETCH ATTACHED <br />IfJSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />!_aterel <br />Abutting t_ot Line <br />N, S, E, W <br />Approved By__ <br />City Engineer <br />Issued B <br />33;�92 <br />Inspection By_ �� ^� � <br />Date Inspected_ 3" 3�' / S _ <br />No. 20915 <br />i� <br />