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everen CHART NO. <br /> � 4 <br /> � <br /> a <br /> � <br /> C.ILy O( EVBfQt[ "3 <br /> � � � 8 8 � 3 <br /> � ^ � M � u^ H <br /> Sewer I�1►pplication and Permit j ` P =' � <br /> � .o <br /> � N �; <br /> � � <br /> 4 � ;? � �°J� r '` � Py <br /> NO. ZF)74.r1 DATE s � =� � � � �� �� � <br /> �T2l�29et <br /> Service Address ,_� <br /> l�tility Account No. <br /> Billing Address_.�� Permit Fee�� <br /> City, State, Zip Connection Charge(s) <br /> Owner (Mortgagor►�:� Total Fee <br /> Billing Name e� � <br /> Comiectian By <br /> Address_ Signed <br /> Phone c�nio,�, <br /> DESCRIPTION: <br /> Lot_�_ Sewer District <br /> Block <br /> Plat __ Monthly Sewer Service <br /> Unplatted Description �_Monthly Sewer Constr. <br /> Typa Permit: ' Trunk <br /> ----_ <br /> Lateral <br /> Remarks: <br /> — Abuttii�g Lot Line <br /> N. S, E, bY ft. <br /> ,4pproved By I <br /> a� . <br /> IMPORTANTI <br /> CALL 1-800d24•66654B-HOURS Issued By�� <br /> PRIOR TO DIOOING I <br /> CALL 269$811 FOR INSPECTION <br /> __ Inspection By� � <br /> Datelnspected_ I <br /> SEE SKETCH ATTACHED NO. ZG f 45 I <br /> WSPf.CTION � <br />