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�rK� CHART N0. <br /> e - . � <br /> City o( Ewntt � �J <br /> / <br /> Sewer Application and Permit �'� ' ' <br /> No. 25381 DATE 12 ,C� <br /> Service Address !7���. r .4t(�IS � �I•J- Utility Account No. <br /> Billi�g Address ��!� ! '^' ' ,` � Permit Fee <br /> City,State, Zip� " ., r r - . _ �', �nnection Charge(s) <br /> Ovmer (Mortgagor)�- � �- ' Total Fee �' � <br /> Billing Name <br /> Connection By <br /> Address Signecl_ i: ��� � 1i"` <br /> cMtomer ' <br /> ?hone <br /> DESCRIPTION: Sewer District � � <br /> Lot Block <br /> p��t Monthly Sewer Service <br /> Unplatted Description �'% � - <br /> Montinly Sewer Constr. <br /> Type Permit: _ _ Trunk I <br /> � Lateral <br /> Remarks: � <br /> I <br /> Abutting Lot Line j <br /> N, S, E, W ft. j <br /> I <br /> � <br /> I <br /> Approved By I <br /> Gry Enpinex <br /> IMPORTANT! I <br /> CALLI�BOOd24-555548•HOURS IssuedBy � ' '� � ' ' - <br /> PRIOR TO DIGGING <br /> CALL 259-8811 FOR INSPECTION I <br /> Inspection By '� <br /> Datelnspected <br /> SEE SKETCH ATTACHED Np, 5381 <br /> I f��SPECTION <br />