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evereH <br />� <br />City oi Evemtt <br />Sewer Application and Permit <br />No. 25409 DATE _���� <br />Service Address_ _=�0 f7th Plaa� S.E. <br />Billing Address 1�� �'! <br />City, State, Zip ��t�, 1ro. 48701 <br />Owner (Nortgagor) �� �at� <br />Billing Name <br />Connectian By <br />Phone u'��1166 <br />DESCRIPTION: <br />lot 1 _, Block <br />Plat Mooill M�nor <br />Unplatted Description <br />Typa Permit: <br />Remarks: <br />IMPOflTANTI <br />CALL 1-800-024�665648�HOURS <br />PHIOR TO DIGGING <br />CALL 269�8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART N0. <br />S�T TO �.�,yt�..�� <br />s-il-e6 <br />Utility Account No._ <br />Permit Fee ��•� <br />Connection Chargels) 3�•� <br />Total Fee ��'� <br />8w�e D�wlop�eAL � <br />Rdlaand 1171-85 <br />x�Ns 179.00 <br />Bw�z •71.00 650.00 <br />Signe� <br />custnme, — <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abut[ing Lot Line <br />N• S• E, W-- <br />Approved By �• n• T�� <br />Gry Enpinen <br />issued sv _ a. eene <br />6.50 <br />330.00 <br />Inspection ByS�.[_'� , <br />Dale fnspected__�,' ZJ - � <br />No. 25409 <br />I�!:,.'I �:11t f�i <br />� <br />� <br />