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Sewer Applicction and Permit <br />No. 22967 <br />Servia <br />DATE _ !� <br />BillinyAddrett = (, ' !/� , <br />' <br />i CitV, Stste, Zip ' ;' i� <br />Owner (Matgapor) • • <br />BillinpNime . . /, / <br />Crannection Bv_— /' 1 i <br />Utility Account No. <br />Permit Fce <br />Conneciion Charge� <br />Total Fee_ <br />� <br />, . �.- - <br />Address - '-----�-- �3 � - Signed_ <br />� � � - customer <br />ati�,.,e • r' <br />OESCfiIPTION: <br />Lot � � � <br />�lat <br />Unplatted Descr <br />B�ock <br />Sewer D <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />- SEE SKETCH ATTACHE� <br />It1SPECTION <br />.�._...�.-�•,..- - • �. . .. -� ._ �_ _._ _ . <br />-•-l�^- asosza . . <br />�tting lot Line <br />N, S, E, W. <br />�rovtd By �/ ' � <br />c��r e�w��e« <br />'•� / <br />ed By " �j � - <br />ection <br />I nspecte+.i <br />N�. �7 � <br />� '�� <br />� <br />