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everen <br />e <br />Ciry of Everatt <br />Sevver qpplication and Permit <br />No. 24023 <br />DATE � <br />Service Address U � ���r��— <br />Billing Address — <br />City, State, 2ip •'��� � "'-�'-- <br />0 , "� __� <br />pWner IMortgapor) - <br />Billing Name <br />Connection By — — -- — <br />CHART NO. <br />� ��.� ����� �� <br />1 � . �_!A� I. <br />r �!, I <br />'1 � �P <br />'. /'��i <br />l. <br />Utility Account No.����--�— <br />� <br />:z <br />Permit Fee___..1� � <br />Connection Chergels)___L�� — <br />% <br />Total Fee_—_ �� <br />_ Signed c�s�ome� <br />Address <br />Phone �.'�.S ' /O�-� — ------ �er(r�u+- <br />$ewer District ' � <br />�j�js�pgT� �� � <br />� <br />t6t � ck---�A'��--� �,r Monthly Sewer Service_ ��� <br />Plat �"^" � <br />Unpletted Description _ — -- Monthly Sewer Constr. � <br />• il S` '43p <br />Type Permit: <br />Remarks: <br />SEE SKETCH ATTACHED <br />IN$PC( 1 i! ��+ <br />Trunk " � d <br />Laterel �' �3 �'S <br />Abutting Lot Line <br />N, S, E, W <br />� G%L*..ve-Ir <br />App�OVed 811( � �.�, Y E^Q�nem <br />Issued BV_L '-�' <br />Inspection By— ,/ L . <br />Date Inspected �! Lk--T I E31 _ <br />N�. 24023 <br />