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23829 74TH AVE W
APPLIC MON
ri REET ri"LE for
The City of E&ROMh SIUDE SEWER PERMff
4?a //j/ A OUTSIDE 0 INSIDEJk REPAIRS 0
CARD No. .......
EASEMENT No. - ..................
OWNERA4 ... 7h. 0. t4 ............................ ....................... .......... ...................... CONT
. A S RACTOR ..... ....... ........ .. PERMIT No.( ...
rw STREET
HOUSE No. 2-Y ....... . ....... 'Ed.0
--20-m4s ........................................ AVENUE LOT No . ........... 3 .............. ................ .......... . ................. BLOCK No . ..... 17 ........ ....................... ......
NAME ADD
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Date Approved:
BACKIFML WORK ORDER ISSUED ........ .............................. DEPOSIT,
. ........... ....... ..................
SEWER WOAK ORDER ISSUED .................................
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