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CHART N0. <br /> Ieveren <br /> � e � <br /> i <br /> I � <br /> CI� O� EVQIBtt '� g � � Q � Y� <br /> � � �� � — � ��. <br /> � i � <br /> .� w . �.— . <br /> � .� <br /> Sewer Application art�,�e�rn�t � <br /> .] � i � r � i � � I <br /> �� �` r � W � ^' � � � ,y <br /> 26426 3 = � � =_ � � WY � '� <br /> NO. DATE oclnb�r 2�. 1987 <br /> Service Address 1�27 – 100th 8t 8M 136 Utility Account No. <br /> 8illing Addr�ss ta�� – tne►e ne nr �u Permit Fee �e_oe _ <br /> City, State, Zip i...r.�+� r� oe�na Connection Charge�s) <br /> Owner (Mortgagor) W � L'IN r e..,�,,.�.. Total Fee_ �e pp_ <br /> Billing Name s.�. <br /> Connection By <br /> Address Signed <br /> Cuftomer <br /> �1011B <br /> � <br /> DESCRIPTION: Sewer District ,nsd !Li I <br /> Lot � Block <br /> Plat._ ��� Monthly Sewer Service __ <br /> Unplatted Description �'� p� Monthly Sewer Constr. <br /> Type Permit: Trunk <br /> Lateral <br /> ' Remarks: <br /> 4butting Lot Line <br /> N, S, E, W ft. <br /> I <br /> Approved By �� R• ��' <br /> Ciry Enpmen <br /> IMPORTANT! <br /> ISSUCd By w���t MQZ'�OQ <br /> CALL 1 600-424•6665 4A•HOURS — <br /> PRIOR TO DIGGING <br /> CALL 269$811FORINJPECTION <br /> Inspection By <br /> Date Inspected I <br /> SEE SKETCH ATTACHED Nq, 264Z6 <br /> IN�PL'C110N I <br />