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N.�„C �••Z�•.'tq CHART N0..1J—bV�� <br /> .everRtt �1 Uc, �I�I 9�� � f O sTG'D <br /> � �y,���� ��- 7-�7 <br /> �a <br /> City of Erxett <br /> $ewer Application and Permit <br /> N0. 23134 DATE '� f � — <br /> � ' ir <br /> S- �-� � '�i� '' Utility Account No. f <br /> Service Address :�.= <br /> - Permit Fee ' '� <br /> Billing Address - - � <br /> --�� � _y;�' Connection Charge(s)_`�'�i� — <br /> City,State, 2ip_ � <br /> pwner �Mortgagor� <br /> _ . Total Fee ' <br />� Billing Name <br /> 4 _ <br /> y Co�nection By <br />; � � , Signed c�:+o�� <br />�,. Address <br />� Phone ' `� ' � <br /> Sewer District L � �� <br /> 4� DESCRIPTION: , <br />� Lot_ Block Monthly Sewer Service � <br />� � ; � � // <br />� Plat - � <br /> Unplatted Description , '� � ' Monthly Sewer Constr. <br /> ____-- Trunk ✓ <br /> 7ype Permit: Lateral <br /> Remarks: Abutting Lot Line ft. <br /> N, S, E, W <br /> �t- — <br /> , Approved BY c.�v e�9�e� � <br /> /�. 'io .oJc�� , <br /> Issued By '� ' — ' � <br /> _�:� .� �?..�.L. _ <br /> Inspection By � _ <br /> Date Inspected ;J � ' 7 �l v <br /> SEE SKETCH ATTACHED <br /> No. 23134 <br /> INSPECTION <br />