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CHART N0. <br /> everetl <br /> e <br /> r,�ty ot evereec <br /> U CL/I2TincEY <br /> ��2/gL <br /> Sewer Application and Permit <br /> ruo. 255�2 �aTe - w�eh rs, ��as — �— <br /> Service A�dress�r�_� S� Utility Account No. _ __ <br /> Billing Address__ .����� Permit Fee_��__ <br /> City, State, Zip_ Connection Charge�sl_ ,_ <br /> Owne• (Mortgagor) _ Totel fee_ • <br /> eillinp Name_��__ 5pet1al Se�nr CMrqos flrA, 1171-R5 <br /> U�ter � 170,00 <br /> SeMer • 471.00 <br /> Connection By�_ _ �.� <br /> Address ��_ Signed <br /> —a:���� <br /> Phone 65l�9S�i -- — <br /> DESCRIPTION: Sewer Di�trict����__ __ <br /> Lot�_ Block <br /> Plat Manthly Sewer Service__ ____._._____ <br /> Un�latted Des��ription _ _ Monthly Sewer Constr. <br /> Typa Permit: Trunk , ___ <br /> r••tttdlolGt�At.t ---.--� <br /> Laterai <br /> Remarks: <br /> " Abutting Lot Line <br /> —_ __ Pl, S, E, W __ ft. <br /> I <br /> —------�--- i <br /> -- -- — ------�Ap��roved EY— <br /> �� �o� <br /> Ih1PORTANTt � <br /> CALL 1800�424�65F648�!IOURS ������� 8y����N�-- — I <br /> PqIOR TO DIGGING i <br /> CALL 2698B11 FOR INSPEC110N , <br /> � � � � �/,i4 L .. �^r_ . <br /> --_------ --- Inspecfion By_1_j.�__ . . � <br /> ------ ---- t- <br /> � � <br /> - ---- ----- - -- Date I nspected_ ; r7 �l ,- _ <br /> SEE SKETCH ATTACHED No. 25542 <br /> IiJSr�i:i�. l iUl' I <br />