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evc�rc�tt �.iiAHr N0. ` _ <br /> e '�� s =`" � � <br /> City ot [vere9t <br /> �� Engineering & Community Services <br /> Sewer Applicotion and Permit <br /> NO. f1ATE -- - � � <br /> Service Addressl F/ / /- : .:�i , �rlity Accaunt No.= - - i 1 <br /> Billing Address_i n ' !/ J /f/G . ""� <br /> �`�-=� Permit Fee i �' <br /> City, State, Zip:.: � '•�� l��- . �r�: G 3 Connection Chargels�_ �7S s�' , <br /> Owner (Mort a or ' � " � _'.r i ' I <br /> ; . ����- <br /> 9 9 I �*�' _ Tnt;d Fer <br /> Billing Name_ �..._ � <br /> Connection By_- _� <br /> .� <br /> i ' � % - <br /> Address_ : � - <br /> --- Siyned_� / '^ % . t�..l <br /> _ .�.1-::_ . <br /> r�lOflB__._ ��'_..' �/" U !� Cut�amrr <br /> . '�'—'— . '' • . . .____ <br /> DESCRIP'�ION: -� -: <br /> Sewer Disirict�•/ 1�. % , <br /> Lot_ � Block------- <br /> Plat_ _�_� � Monthly Sewer Service � '� <br /> Unplati��dUescripLon_ : �_:� ,: ! -__ ___ _ _ y�onlhlySewerConstr. <br /> TYPe Permit " i�, .r (.�-, �'7' Trunk_—=— <br /> Lateral <br /> Remarks: - <br /> � ._. . Alni�iniu �ut l.irn� <br /> _— , ,. � '.V � r� <br /> i .. . �AppruvedBV_—_. <br /> ' � �,, . ,� .,, <br /> I , <br /> � Issued By%. _ .^-� <br /> -__ ------ -_ Inspection 8��___a�� - � �`. � <br /> _ - f �__' --. _ - -- Date Insperrad._ (Q�ja�" - <br /> f <br /> SEE SKETCH ATTACHE\ NU. <br /> �:: __�� <br /> � <br />