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CHART NO. <br /> evgre <br /> e <br /> City of EvPrett <br /> Sewer Applica�ion and Permit <br /> No. 25439 DATE - <br /> Service Address �`V � P4� S� Utility Accaunt No. <br /> ''�� � �'�-�-/A�✓�_ Permit Fee � � <br /> Billirg Address�� <br /> City,State, Zip ' � _ Connection Chargels) <br /> `�^� �— <br /> Owner (Mortgagor) Total Fee � - �J <br /> Billing Name - . <br /> Connection By����`� <br /> ' Signed - <br /> ' J <br /> Address ' � a:�o�� <br /> `�`� C <br /> Phone � �x ��`� � <br /> DESCRIPTIO • Sewer Disicict <br /> Lot �' Block�� Monthly Sewer Service <br /> Plat 1/L��r � <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br />' Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N S E� W ft. <br /> _.--- i � <br /> Approved By � / • � • <br /> City Enqineer <br /> IMPORTANTI . <br /> Issued By <br /> CALL 1�800-024•5555 48•HOURS ,� <br /> PRIOR TO DIGGING <br /> CALL 259-8811 FOR INSPECTION <br /> Inspection By� G"��"''�� <br /> Date Inspected 3—y �� <br /> SEE SKETCH ATTACHED No. 25439 <br /> INSPECTION <br />