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evereM <br />e <br />Cfh/ O� EYBIQtL <br />!, I <br />�� ���✓�5��� � ; � <br />j� i�, <br />Sewer Application and Permit <br />No. 25644 DATE �,�oaR <br />Service Address �y�_+.+c .�.r.r_, <br />BillingAddress y��� ..-�----+ <br />City, SUte, Zip �.. ... m+e, <br />Owner (Mortgagor) �,��;��� <br />Billing Name_ <br />Connection By ■.�. <br />Address .�. <br />Phone K,�+.e.. <br />CHART <br />Tb CNt�.eT�.�/Cr 3� 3��8 % <br />f%Lo.vS LJiTi! i�cuE C��./� <br />ZO B= !'=TL.f�✓.so. <br />Utility Accrn�nt No. _ <br />Permit Fee��..� � �i� _ <br />Connection Charge(s) _ <br />Total Fee {6e_ee <br />S�cial Sw�r PNs �rd. 1171-BS - IhrN�atM <br />$188.78 <br />Signed ~ �`'�- <br />cu:romer <br />DESCRIPTION: Sewer District <br />Lot s-'/.°�L,2�-3���ck ��3 <br />Plat Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Typa Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1SOOd24•5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 2598811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />�iv �o��ee� <br />!ssued By n_ ra..m.., <br />Inspection BV —��� <br />l <br />Date Inspected �' 7-F� <br />No. 25644 <br />I��SPEC I'lON <br />.� ` <br />