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everen <br />� <br />c�ey or e�eren <br />Sewer Application and Permit <br />No. 25380 DATE 1 Z� 1�7 -�S� <br />CHART <br />%e Oca.✓ �.o C//e�,-..v� <br />/�,�� <br />Service Address �� "� Utility Account No. <br />Billing Address ��� '� �� LU� �_� <br />Permit Fee__�– <br />City, State, Zip <br />Owner (Mortgagor) \ <br />,1 <br />Billing Name � <br />Connection By = ( <br />Address_ i �%i���(%(� � S� <br />Phone— 3 3�-'ar��y� <br />Connection Charge�s) <br />5 �� <br />Total Fee <br />Signed ' <br />Cuf�OrtMf <br />DESCRIP�jJ.QT! Sewer District <br />Lot.�� plock � <br />Plat �- �7K'L./�t16 l0 �✓ Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />�Ype Permit: , <br />Remarks: <br />IMPORTANTI <br />CALL 1�800-024•5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 2595811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Enpinem <br />Issued <br />I nspectio n <br />Date Inspected <br />INSPECTION <br />No. 25380 <br />� <br />� <br />H '~+1 <br />�� <br />� <br />� <br />� N <br />z <br />� <br />�� <br />�� <br />�� <br />� <br />. � <br />� <br />� <br />M <br />� <br />�'] <br />Hn <br />[�1 <br />