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NMC�1 <br />e <br />City of Evsrott <br />Sewer Application and Permit <br />►a. 28540 DAT[_ n.e.�*.. i� +s9i <br />Servfcz MCress —4opZ.Ado�a�w„_ <br />a�n�rq ney•.ss -sa�, an�s a.�. — <br />i <br />� City, State. Lp �t, �p iyW <br />Owr�er <br />i Conr.ection 6y y�nea� iaa <br />i <br />i Address <br />� —�—+�=r' �q4 MOq <br />I <br />; PMne _-Ny_pu.l— <br />� Legal Deccrip�ion: <br />i <br />Lot . <br />i <br />BloCk — <br />Plat <br />Urplatted Descnption: <br />Typo ol Pertnil <br />Remerks _ <br />fi,',l•S•7��\ijil <br />CALL 1-800-424-5555 48-HOURS <br />f�910R TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />u:ii�ry Aarount No. <br />CHART NO. <br />�, onsriNc 3,w:�: ��. <br />t�,� . ,,,:::�,.�,� ,. t� <br />i <br />aiYYlfiaoS <br />S Wl7i , ._. <br />caa�e <br />I s�r�r �:..., <br />UEt7�. f..�l' <br />Permit Fee � i.50 <br />Connection Charge <br />Trunk 5 <br />Laleral S <br />Total Connection Cnarge 5 <br />Utiliry Developmem Fes <br />Water 5 <br />Sewer E <br />i�otal Development Fee E <br />Sewer Bond Distrid <br />Abutling Lat Line <br />N, S, E, W — <br />Approved By ._. <br />�ssued By �� <br />Customer Signature <br />Inspection By ����� <br />Date Inspected l�-� �� �� <br />INSPECTION <br />NO. ZS'J4O <br />n. <br />