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� everefl CHART N0. <br /> I � j�r' <br /> C.IL�I O/ EvBIQLt <br /> R <br /> � � �' g � 'L� <br /> � � O O � y+ <br /> Sewer Application and Permi� . � � � � � � M <br /> N0. Z63O4 DATE �� � $ � � � � � �� � <br /> . r <br /> 5ervice Address Utility Account No. <br /> Biliing Address =- _ Permit Fee <br /> City, State, Zip Connection Chargels) <br /> Owner (Mortgagor) Total Fee <br /> Billing Name � <br /> Connection By <br /> Address I <br /> ,- Signed <br /> Phone Cuslomer <br /> DESCRIPTION: Sewer District__ <br /> Lot �� Block <br /> Plat����a� Monthly Sewer Service _ <br /> Unplatted Description Monthly Sewer Constr. <br /> Type Permit: Trunk � <br /> • I _ Leteral <br /> Remarks: <br /> Abutting Lot Line I <br /> N� S• E, W ft. � <br /> I <br /> � <br /> � <br /> Approved By i <br /> IMPORTANTI � I <br /> CALL 1�BOOq24•6666 48�HOURS <br /> Issued By � <br /> PRIOR TO DIOGIN3 i <br /> CALL 269�8811 FOR INSPECTION � <br /> Inspection By___ <br /> Date Inspected � <br /> SEE SKETCH ATTACHED Np, ZG3O� <br /> If�1:;Pf:r)�7Ci! <br />