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� <br /> i <br /> I <br /> CHART NO.�"�'� � F"--_ _ <br /> everetl .�.," �/l�/° i ' <br /> � <br /> , e <br /> City of Everen <br /> � <br /> Sewer Application and Permit <br /> Septewbet 1�, 19A4 <br /> j No 24925 DATE - ---- -- - -- ' <br /> i )02 107th I�leai P.t. 76�1��s i <br /> Ser�ice Address ----- ----- — Utility Account No. <br /> I -- <br /> 0 <br /> K�n M=q'17�29 �7[A A�ow „.E. Pe�mit Fee_ 30.00 -' <br /> � Billing Address_ — m <br /> 1lrlinqtou. M�• 98��� Con�ection Charge�s)_ ��•� �� <br /> I City,Statr„ 2ip ___- — ,..,,., <br /> IOwner (Mortgagor) �A �� - — --- Total Fee----_-- �0•� — i „ � <br /> � Rm1 !M[4 <br /> Osdlnanae S8�-B3 800.00 j `� m <br /> ' Billing Name � <br /> I m` <br /> Connection By <br /> � o� <br /> —1 z <br /> Signed__ <br /> -, <br /> � Address — c�mn�. m <br /> I � _ <br /> � Phone_- 6S9-6E17 _ _-- � 22I ' � x <br /> � Sewer District_____—_----- - � �v <br /> iDESCRIPTION: � „ <br /> Lot x Block_--- 6.50 � � <br /> Monthly Sevier Servicr,_-__-- - <br /> ! w��k CrMk Di�_1 -+ <br /> Plat -- <br /> Monthly Sewer Constr. m v <br /> II U��G�^tted Description _ - —�-- — <br /> 0 <br /> _ Trunk ��'� i Pi^ <br /> i � � <br /> Type Permit: 1NM Osna�aeia+ � <br /> — ----- _ Lateial _ __---- �ec� <br /> — - �r <br /> . m <br /> i — ------ - a <br /> Remarks: Abuttinc Lot Line p <br /> � -- N, S, E, W------ _ --- ft. T. <br /> I =' <br /> ---- z <br /> -- , <br /> i. <br /> AnProved Bv 11. lt. SR�1--- <br /> I c�rv E�o����� - <br /> � __ ' <br /> 6. beA � <br /> — Issued BY----- — <br /> � <br /> � <br /> I � ,� . <br /> � (1�,���� �jQ(� <br /> - ��-�=---�-1�`> <br /> Inspectiun By -- <br /> � ,.�..,,.. -- _ - - � " <br /> �� -- i . � <br /> - <br /> n � -- <br /> � _ Date Inspected_ �1" �_ -- `.__ - <br /> I SEE SKETCH ATTACHED Nn Z�9Z� <br /> � r � �; <br />