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1�1 �d -C �-`� - � � <br /> CHART NO.�` I 7"�S1 <br /> everetl ..; ��� <br /> � . $ s�,� <br /> � � <br /> c;�y o, E,re►� � <br /> � Sewer Application and Permit <br /> No. 23125 <br /> DATE �� � � � � <br /> ���� _j � - � . > . Utility Account No. ; <br /> Service Address �, �, �r <br /> � �� �� ;jO �G PermitFee � — <br /> Billing Address <br /> � -� '".�- j�.� J� Connection Chargels) <br /> City.State, Zip ,,�� <br /> ' J /_J <br /> � Total Fee <br /> Owner (Mortgagor) � '�� --`-=--7 <br /> gilling Name �"' <br /> Connection By " -� _�- <br /> : :; Address Signed � _ auome.-- <br /> ,:i� . ';.� , , — ' . <br /> ,''; Phone � � . - // i <br /> , ` `'- Sewer District <br /> "� '. DESCRIPTION: / / _ <br /> Lot %' - 'y — Block T Monthly Sewer Service <br /> Plet %-'+ -- � C.: ,.- L_ <br /> Unplatted Description Monthly Sewer Constr. <br /> --- <br /> Trunk <br /> , i <br /> Type Permit: �j/, - � - - <br /> Laterel <br /> ' Remarks: Abutting Lot Line , � --= <br /> � N S E W --^I ft. � <br /> i <br /> I <br /> �o o J6 - -� � <br /> APProved By c�ry e�w�oeer <br /> luued By . �� ' <br /> Inspection By <br /> .� vV � <br /> Date Inspected 7 � � 3� 7 <br /> -- No. 23125 <br /> SEE SKETCH ATTACHED <br /> INSPECTION <br />