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eve�e„ <br />� <br />ctey of e�cc <br />r <br />� sss $ ggsQs <br />� ��� � ���r� <br />.w w .w <br />�n <br />Sewer Application�vr�d.� ' it <br />�� <br />�f � � ������� <br />NO. 2 1451 DATE"� � �D�� ~ .. �t-i!e!— <br />Service Address IOS f7th it. YR <br />Bflling Addreaa =�=5 196th *l. �M <br />City, State, Zip �� � �K <br />Owner (Mortgagor) �°l� 0°°���0° <br />Billing Name � <br />Connection (iy �� <br />Address � — <br />Phone 77h71S6 ^ <br />UESCRIPTION: <br />Lot S Block — <br />Plet — <br />CHART <br />TO POSTlNG — '-c <br />Utility Account No. <br />Permit Fee_ 30.00 <br />Connection Chargels) 3�0.00 <br />Total Fee �� � <br />Otllity D�hlop��t TN OrA. 1171-85 <br />•at�z 179.00 <br />�w�s 171.00 � <br />6SO.OQ `� <br />f � <br />Signed <br />co.roms. <br />Sewer Uistrict � �� ==I <br />Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1�800�424�6666 48•HOURS <br />PRIOR TO DIOOING <br />CALL 269�811 FOR INSPECTION <br />SEESKETCH ATTACHED <br />Trunk 330.00 <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_ <br />Issued By <br />/ <br />Inspectio� By <br />Date lnspected �' <br />No. 2'1451 <br />I N:�PECTI OfJ <br />