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evereK <br />e <br />r�� o, Ew..n <br />`�ewer Application and Permit <br />No. 25382 DATE c.� ie, ises <br />Service Address s�ei wn���� Utility Account <br />Billing Address �n>>��� ��� <br />City, State, Zip�wt +d ltt03 <br />Owner (Mortga�or) :t�sllay J�s <br />BillingName- �z��� �� <br />Connection By ■.Y <br />Address <br />Phone �i� i0u <br />CHART <br />, <br />��i:l � ' J .. `..: '!.y^ -- y,S' , <br />F /:,; ; E,=: <br />Permit Fee ]0.00 <br />Connection Charge(s)_ ne�� <br />Total Fee ]0.00 <br />s�wr D�►�lep��t M Oed. 1171-tS <br />!leql� feilt r��id�so� <br />Mabr 17l.00 � � <br />srwr l71. 00 <br />Signed <br />cu:tome� <br />DESCRIPTION: Sewer District <br />Lot R Block <br />Plat — ��1a�d �'r Menthly Sewer Service <br />Unplatted Description ■ 1m� .�Q�L tae �R Monthly Sewer Constr. <br />Typa Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-800�24555548-HOURS <br />PRIOR TO DIGGING <br />CALL 259�BS11 FOR INSPECTION <br />SEESKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />itv Engmav <br />Issued By_ � p��._ <br />Inspection By� � b�/ti�� <br />Date Inspected �i � 3 v —�� <br />No. 25382 <br />Ii�JSPECTIUfJ <br />