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veretl <br />� <br />City of f . �ett <br />Sewer Applicati�on and Permit <br />rvo. 27789 <br />DA'i E � /! . �/ <br />Service Addres� ��Z F (�! � K��I_�� <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor�_ <br />Billing Name <br />Connection Byf I'�'��� � �' 6��'� l''F' �"�' <br />Address <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Type Permit: <br />Remarks: <br />Block <br />IMPORTANT! <br />CALL 1-800�24-5555 48�HOi1RS <br />PRIOR TO DIGGING <br />CALL 259�8871 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />ICHART <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s) <br />Total Fee <br />Signed <br />Cus�omer <br />Sewer District <br />Monthly Sewer Service. <br />�onthly £ •wer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engineer <br />Issued BY_Q����� ��.� Y- i <br />Inspection By< �%����X��� i <br />/ <br />Datelnspected /—/!1"- 'l�/ � <br />No. 277t39 I <br />U;-i(..i�i' �.I;.i_i;�G <br />