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everen <br />e <br />c�ey �s e��tt <br />Sewer Application and Permit <br />N0. 23234 DATE ��/- " � � <br />Service Address.�L.1J �/1 �-c� Gl Utility Account No. <br />�/ <br />Billing Address �� ' f" �7 = v' ' Permit Fee <br />City, State, Zip ! � i'' �' Connection Charge(s) <br />Owner (Mortgagor) ' ! Total <br />Billing Na <br />Connection <br />Phone � % '� i u ; ; � <br />C�ESCRIPTION: <br />Lot � � �' Block `� � <br />_--^---- <br />Plat � <br />Unplatted Description <br />Type Permit: ,, - - <br />' <br />Remarks: ��o�(jC.TG� I �—� <br />� N� c_.� c. /t I.�- F� R 1 N�P. <br />n <br />r� <br />-; �-- _, J . ,.�%`� <br />Signed <br />Cus�omer <br />Sewer District <br />Monthly Sewer Service. <br />Monthly �ewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />.� � � <br />Approved By ' � " <br />d CitV Engineer <br />, ��, , issued By <br />SEESKETCH ATTACHED <br />INSPECTION <br />Inspection <br />Date <br />rvo. 2323� <br />ft. <br />