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everen <br />� <br />C�ty of Everatt <br />Sewer Application cund Permit <br />NO. Lv�vo DATE _�k , <br />Service Address 5711 loand 1►�+. <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name �-- <br />Connection By <br />Address <br />Phone <br />DESCRIPTI ON: <br />CHART NO. <br />�,.���, <.�-- y, .�� io-�o g4 <br />Utility Account No. <br />Permit Fee <br />Connection Chargels) <br />Total Fee <br />Sp�alal Utilitp !M OcQ. 1171-�5 <br />rat.�z 17J.00 <br />Signed <br />/ .CuftorrK'� <br />Sewer District <br />�ot�_ Block Monthly Sewer Service. <br />Plat '�'--�-6-!1 — , <br />Unplattnd Description Month,y Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-800�24-5555 48•HOURS <br />pqlOp TO DIGGING <br />CALL 259•9811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot �ine <br />rv s e u�lo��'tie; �i:s�u� ot�rr�t �{�R <br />t <br />�uHnxr;sas <br />bk1iER Fti50.00 <br />N(bAl2ezea <br />� ! <br />Approved By � � <br />-$iM�E�Linee►� � �.w <br />IiUQQ1it�.S <br />Issued By.����-�— <br />7tEf.H 597.`�! <br />�t <�Y. { C3.5(1 <br />L: `' #15. <br />�'11.110 <br />Inspection By UIE�'Y, iN+f.�..:�1 <br />Datelnspected �-� y � <br />No. 26368 <br />li:S; EGTIQ?J <br />