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i <br /> f �RT N0. _ <br /> everen i <br /> e � <br /> City of Evemn <br /> Sewer Application and Permit <br /> N0. �v28`� DATE � +. ,m+ <br /> Service Address 1�7 ieotw_ �_ ar y= ap �,y� Utility Ac� •nt No. <br /> Billing Address � Permit Fee_�,.... <br /> City,Stato, Zip ����e, n� 9eznt Connection Chargels) <br /> Owner (Mortgagor) �.�. ��. Tutal Fee_yp,�.. <br /> Billing Name L� <br /> Connection BY �� ��• r+�+��• �� •----Mrt <br /> Address Signed <br /> Cuslomer <br /> Phone �65—���+ <br /> DESCRIPTION: Sewer District I <br /> Lot • Block <br /> Plat +�'�v a�Lt�. Mor�:�ly Sewer Service __ <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Typa Permit: ��.� y�_�M��� <br /> Lateral nt:_i:n: �:��rv+ tynaetim.' llc+ <br /> _ ; <br /> Remerks: Abutting Lot Lineb����l���'1 <br /> N S E WIM'1.�11 �t0.IN1 •� <br /> 1.� J <br /> ��.�.� �.1J.�� <br /> �u�xirx:�,in <br /> 4V�t[.� rho.�lU <br /> Approved By utKkilttt�.:S <br /> I <br /> D�� <br /> INMN I.�':..t::� <br /> IMPORTANTI !a.4A}: ,�1U,UU <br /> Issued 8y <br /> CALL1A00124-566548�HOURS - �• <br /> PRIOq TO DI�GING <br /> CALL 269�8811 FOR INSPECTION <br /> Inspection By <br /> _ _ Dat.: lnspected <br /> SEE SKETCH ATTACHED NO. 262SS <br /> li;l,f l C i IOf`J <br /> I <br />