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�.�. <br /> CHART N0. <br /> everetl <br /> I <br /> e <br /> c�N ot e�eren <br /> SeNrer Application and Permit i <br /> NV Z63SO DATE �b.r ia_ iqn� <br /> Service Address Uti!ity Account No. <br /> Billing Address s.Y Permit Fee�e 00 <br /> City, State, Zip� y�� Connection Charge�s)_ <br /> Owner (Mortgagor) .._ ..�„M...._�__ Total Fee <br /> Billing �ame .� <br /> Connection By <br /> Address �,���e �� ����_ Signed _ , <br /> Customer <br /> Phone 93S-�NS -- I <br /> DESCRIPTION: Sewer District_ <br /> Lot_-i�e Block <br /> Plat— Monthly Sewer Service <br /> l�tsMyLi�tat�� <br /> Unplatted Description Monthly Sewer Const•. <br /> Type Permit: Trunk <br /> lbDila Bar Wnn�etim <br /> Lateral � � <br /> Remarks: ' <br /> Abutting Lot LineilU�K"t7ft`";a <br /> _ N, S, E. WCL.fC 42'a.l�i ft. <br /> I�:UI i:'�'aJU <br /> �,r�r,r �:tu.�u� <br /> r <br /> t:i M a n i';;'f <br /> AN,11 e eoU.(�] <br /> — — APVroved ey wtr�Nl�%9Fltasr. <br /> I <br /> —�t��Enyinexl . 1.�A� <br /> IMPORTANTI C�,�xr,�iu�� <br /> CALL 1�BOOd24•566648-HOURS Issued By s�u�fY�a�i�e �10•lq <br /> (ly.Cl; 4115.fK] <br />' PRIOR TO DIaGINC <br /> CALL 269A811 FOR INSPECTION <br /> In,pection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED NO. `v�oO <br /> IPJS�'LCIIUN <br />