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everet�.• <br />� <br />C;ty ot Everen <br />- ,�,_-+�2-5 <br />CHART NO. '�--�— <br />��."l� y"�:�'8� <br />� ,,_ <br />� <br />Sewer Appl��ation and Permit <br />.����a� <br />N0. 2��56 DATE <br />y:1 lOSth P1aQ• s.E. <br />Service AAdress_----� <br />?.O. fo= 41! <br />� <br />Billing Address M� 9820� <br />1Cirklana, <br />City, State, Zip�—�— <br />ih�istaA i Ml111��� <br />pwner IMortgegorl <br />s.■• _ _--- <br />Billing Name�-- <br />sR■• <br />Connection BY — <br />e=�-o�ss <br />DESCRIPTION: <br />Lot�-- Block _ <br />Plat — *!= 6��= <br />Unp�etted Description__- <br />7ype Permit: M�r Cesn�etlon <br />Remerks: <br />SEE SKETCH ATTACHED � <br />Utility Account No. ' <br />�0.00 'I <br />Permit Fee <br />»0.00 <br />Connection Chargels) <br />]O.oO <br />Total Fee_ <br />orAin�nc• �715-l0 »y,00 <br />7�r�a 1 <br />1 <br />� <br />_ --�--- <br />Signed C��;mmer <br />�6 600a III <br />Sewer District.__--- <br />5.10 __ <br />MonthiY Sewer Service <br />Monthly Sewer Cunstr. <br />1,25 �70.00 _ <br />— Trunk <br />Lateral_ <br />p.butting Lot Line <br />N, 5, E, N1 <br />�,, p. Sb�a1 <br />q(lproved BY C,v E„y111e� <br />E. Boad �i <br />Issued BY --- - � <br />/ <br />INSP[CTION <br />µ.,^- - <br />Insp�tion By-- <br />��� {q��/��)c �� <br />Date I nspected 1s�='-°_„ _—'�— � � <br />No. 24056 <br />