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CHART NO <br />Sewer Application and Permit <br />NO. 263121 DATE AUVWt. <br />Service Address 1415 12 At sm <br />Utility Account No. <br />Billing Address- 6- 22" <br />Permit Fee 30.E <br />City, State, Zip Lunnumad,Ift 38M <br />Connection Charge(s) 290- <br />Owner (Mortgagor) t-Wkey <br />Total Fee 30.00 <br />Billing Name <br />1p " ,�.ity Ord. 1171--851 <br />,f", <br />Connection By 11skm a Asili= <br />1� 471.E <br />- <br />650.00 <br />_ Address Sam adid3ass <br />Signed �'• <br />Customer. <br />Phone <br />DESCRIPTION: <br />Sewer District Bond III <br />Lot gg Block <br />Monthly Sewer Service <br />Plat s <br />Unplatted Description <br />Monthly Sewer Constr. <br />Trunk <br />Type Permit: MW Commotion <br />Lateral <br />Remarks: <br />Abutting Lot Line <br />N, S, E, UVMIX ft. <br />s <br />PLOG M.00 <br />MIDI $20.W <br />$34,,78 <br />Approved sy <br />nginee�' <br />a <br />IMPORTANT! <br />Issued By <br />CALL 1-800-424-5555 48-HOURS <br />12 <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />Inspection By <br />(c� i w <br />v <br />79 7 <br />Datelnspected <br />042 <br />SEE SKETCH ATTACHED <br />NO. <br />I N`SRECTI ON <br />