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everen <br />e <br />City of Ewrett <br />Sewer Applicction <br />N0. 27722 DATE <br />CHART N0. <br />�e�� .�, ��+�,� � ,5 4, <br />Service Address c+� u�aai..a er <br />iu� uer nr <br />Billiny Addreu * - - - <br />City, State, Zip r+uy�� d�x <br />Ownx (Mortgegor) w,.�►��. C._LILlMw <br />Btlling Name_ _.�. <br />Connection By — <br />Addrau _ <br />MIOn!- �fi�OSf� <br />DESCRIPTION: � <br />Lot�� Blxk�_ <br />PI�t � f�wrly fia� nl��= 2 <br />Unpiatted Dexxip <br />Pe►mit: <br />Ramarks: <br />IMPORTANTI <br />CALL 1�OOd24-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL269�887TfOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee 70.00 <br />Connection Chargels) Sf�.2S <br />Total Fee ]0.00 <br />DtilitT Drwleprwt <br />wa: ssi.00 <br />..wr se�.00 <br />!M, Otd. 11719lSr <br />lN.00 , , <br />i; <br />Signed _ <br />custome. <br />Sewcr District �a I <br />Monthly Sewer Service <br />Monthiy Sewer Constr. <br />Trunk lo�.so <br />Lateral ��l,7S <br />Abutting Lot Line <br />N S E W 7S• <br />Approved By ��* enrroen <br />City E�pinaw <br />Issued By 11�c�r�c MeLee <br />Inspection By--5�� -' <br />Oate lnspected �� r0 <br />INSP[CTION <br />NO. 27722 <br />