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CHART N0._ <br /> everen <br /> e <br /> c��y ot e�eren <br /> Sewer Application and Permit <br /> N0. �s16O DATE _April s2 . 19e7 __ I <br /> Service Address 1427 l0�xw �t nr /a Utility Account No._ <br /> Billing Address sas Permit Fee �� �� <br /> City,State, Zip �*+�*- ri 90204 Connection Chargels►_ � <br /> e�.... .+".rt Total Fee 10.00 <br /> Uwner (Mortgapor) Rn� <br /> Billing Name s� i � <br /> 1 / , I <br /> Connection By � J( I <br /> Si ned , ( ��_. .� <br /> Address 9 c��o�, <br /> Phone �n_ae�g <br /> DEC :HIPTION: <br /> s�e. o�:c���c Bond III <br /> l.ot 4 Block Monthly Sewer Service <br /> Plat ���LEwY �u�� <br /> Unplatted Description _ _Monthly Sewer Constr. <br /> ' Trunk <br /> Type Pennit: 11w :•mmation – Mobil� Itow <br /> ' Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N S, E, W_ ft. <br /> — Approved By it.v�•vn o ��ne�r. <br /> Cny E�p��ex <br /> IMPOHTANTI <br /> Issued By ►9�raant s Mai�oA <br /> CALL 1A00�424-566648-HOURS <br /> PRIOR TO DIOGING <br /> CALL 269�8811 FOR INSPECTION <br /> Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED Np, Z61GO I <br /> G:':'iL' iIO�J <br />