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evt�reri <br />��e� <br />�, c;cy or e�e�ecc <br />� <br />�I Sewer ��piication and Permit <br />CHART <br />Pos�� <br />3-Zs-�z <br />V-�'� <br />�i9i�z � <br />N0. Z:l.2Q3 DATE <br />'i Service Address 1932 Virqinia Utility Account No. <br />II Billing Address Permit Fee <br />None <br />City, State, Zip Connection Charge�s) <br />Owner (Mortgagor) <br />Total Fee �one <br />� gilling Name <br />Connection By City of 8verott <br />Don Hiller <br />Address _ Signed c�s�om�� <br />Phone <br />DESCRIPTION: <br />I �at Block. <br />Plat <br />! Unplatted Descriptio� <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Latcra�_ <br />ng lot Line <br />N, S, E, W_ <br />SEE SKETCH ATTACHED <br />�i 'EC <br />HT.XS0fi8 A. &. Theal <br />ved By <br />Ciry Enginear <br />E. Dond <br />By <br />;tion By - -- <br />nspected — - -- <br />No. 24203 <br />t <br />