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CHART NO. <br /> !YKlQ <br /> e � <br /> �, � � � � � . <br /> � � � Mx <br /> _ <br /> S�wer Appl'Kation and Perr�il� � � � <br /> c � � m � � <br /> NO. Z��!rSv DATE !�!t Jalr�. 1let _ <br /> ��q q��p.j 1�M �11dtJ� MQlW _ Utility Aceount No. <br /> &Ilinp Ad�!ress �� �_ � Permit Fee =•� <br /> City,Sute, Zip ���� � Connection Charge(s) <br /> Owner (Mortgpor) �M �L Total Fee =•'� <br /> Billinp Name �� <br /> Connection By <br /> - <br /> Address Signed � ' �-"'�� <br /> customer �z��. �—.. . <br /> �IOfl! '. <br /> DESCRIPTION: Sewer District <br /> Lot ls • �t Block '� <br /> . Monthly Sewer Service <br /> Pt�t�����{+ i <br /> Unpl�tted Description Monthly Sawer Constr. <br /> Trunk <br /> Typa Permit: e!f <br /> Lateral <br /> R�marks: <br /> Abutting Lot Line <br /> o � �o �. �t� N, S, E. W _ft. <br /> - �G <br /> Approved By Av� �• '�L <br /> Ciry En�inaer <br /> IMPORTANTI � �� �� <br /> Issued By <br /> CALL 1$00124-65651l-HOURS <br /> PRIOA TO DIGGING <br /> CALL 269�8811 FOR INfPECT10N <br /> Inspection By <br /> Date I nspected y'' 3 d ' �'� <br /> SEE SKETCM ATTACHED NO. 2�756 <br /> INS°ECTION <br />