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� __ <br />'�. <br /> F <br /> r� <br />� <br /> I <br />� <br />. <br />� <br />� � CHART N0. Q �7 "Z�� -5 <br /> e�cerett <br />�� <br />` � Pa��� $"5r�� <br />� c�e� of e�erea <br /> . . • � <br /> Sewer Application and Permit <br /> N0. 23560 DATE 7—a�- �� <br /> Service Address �3 �� � '� � f�!/''�'��-•'aj[lutity Account No. <br /> Billinq Address��(1��'� �_-�-?—�*!"-9 6 -- Permit Fee ��f — <br /> 7, <br /> City,State, Zip Connection Charge�s� <br /> Owner (Mortgagor Total Fee � <br /> Billing Name <br /> Connection By � — � �� / <br /> Address Signed � <br /> cu:tomer <br /> Phone ��3'" ���� I <br /> DESCRIPTION: ' Sewer District �---/J { <br /> Lo - � � �lock -��� ,E�fi..f' <br /> Monthly Sewer Service��� <br /> i Plat ���. T- <br />� Monthly Sewer Constr. ' <br />�� Unplatted Description <br /> Trunk <br /> t Type Permit: �� i <br />,� .� Lateral <br />� ��Y�� Remarks: '' <br /> l� �'� -- Abutting Lot Line <br />' _ N g, E� yy ft. <br />� _ <br /> �.S`��� APProved By '7. , . _ / <br /> � Ciry Engineer . <br />� �� Issued By " <br />��� � <br />,i' Inspection By�- • <br /> f, Date Inspected ( 9 �VNE 8� <br />�� SEE SKETCH ATTACHED No. 23580 � <br />,I I <br /> i INSPECTION � <br /> V. _ <br />� <br />�� <br />� --- _ cT-. <br />