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111trlll <br />e <br />Ciqr oi EwRtt <br />i <br />Sewer Application and Permit <br />CHART NO. <br />. �_, cti�, -:.,r ,,.,9 gb <br />N0. 25459 DATE � <!i � <br />Swvice Address�f��,�Q�� Utility Account No. <br />Billinp Addreu `-Y`�-'-- � , � ; /� % � - � �" Permit Fee �/� . <br />�-i__ J, ; � r_ r:: i � !i '�-' � 7 <br />City, State, Zip � <br />Ow�Yr IMortgagor) w! -1 // ' / " ' ' <br />Billing Name '� ( � ( ; � ; � -' �- <br />Connection By— " � ; - . L. <br />�� � / <br />Phone_ _ � i� r: - � . � . <br />DESCRIPTII <br />Lot�Pl�t r <br />Unplatted Di <br />Tvpe Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1�00424•6666 46•HOURS <br />�aiOR TO DIGGING <br />CALL 269$817 FOR INSPECTION <br />SEE SKETCH ATTACHEO <br />Connection Chargels) <br />Total Fee �� �•�" <br />/F <br />, <br />Signed� �''�� \`� �a,�k'v <br />! cuctomer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />� <br />Approved By � � � � L'''L <br />ary enyfoee. <br />Issued Bv � C. � L_<. �; •� ,.: _, . <br />Inspection By <br />Date Inspected_ _/ " 3 O —�L <br />Na. 25459 <br />INSPE:CTION <br />