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!v!rllf %�� O C. <br />� <br />City ot�Ewr�tt <br />�dr6 1 �1 �" <br />� 23.�5 <br />Sewer Appl'ication and Permit <br />No. 2316b <br />DATE �L�–Z�'� <br />CHART NO. S �G ��8�`�--- <br />Servica Addresa..�� F ` ry �� , �'� •�! <' i�. /.�'Utility Axount No. ' . <br />� Permit Fee -' � <br />Billiny AddrasL � � �� � — ---� <br />�; � � ;;.� /p _1= Connection Chargels) <br />Cfty, State, 2ip i <br />pwner (Mortgagor) � � -� Total Fee � <br />Billing Name <br />�_--� <br />Conneciion <br />�• .�; i <br />Signed % t � � � ,'� � �°,1lkrtiJ <br />customer <br />Phone ' " � j �' <br />DESCRIPTION: <br />Sewer District ^ Jr — <br />Lot �` Block � Monthly Sewcr Service <br />Plat ` - � <br />Unplatted Description Monthly Sewer Constr. <br />_ . f �� <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Laterel �'' <br />4butting Lot Line � <br />N S, E, W: <br />,% . <br />Approved BY ��rv E�o���K <br />Issued By ` f <br />Inspection By <br />Date Inspected � �� �� <br />No. 23165 <br />