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evereh <br />e <br />City of F.vzren <br />CHART <br />SFNT To CN9�l�NG �-z% <br />Sewer ApQlication and Permit <br />No. 255R1 <br />Service <br />Billing Address <br />City, State, Zip <br />Owner (MortgaQorl �� <br />Billing Name_ <br />Comiection By <br />DATE <br />Add ess <br />Phone ' ' � — _ <br />DESCRIPTION: <br />Lot Blvck <br />Plat - <br />Jnpletted Description <br />T� �e Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1�800d24�6555 48�HOURS <br />PRIOR TO DIGGING <br />CALL259A811 FOH INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account N <br />Permit Fee �_� <br />Connection Chargels) <br />Total Fee _ <br />, __ <br />Signed — � ��oM. � <br />Sewer District `' <br />Monthly Sewer Service <br />_ Monthly Sewer Constr. <br />— Trunk <br />� Lateral <br />� Abutting Lot Line — <br />N, S, E, W <br />I Approved By_ <br />Ci1y Enpinan <br />Ilssued <br />ft. <br />InspectionBy� �-"� �_ <br />L.J <br />�Date Inspected_ y (� /� _ <br />No. 25561 <br />in�;;r��c��i�,r; <br />