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�p � p _ _ — -- <br /> � i CHA��T NO. -- <br /> r N <br /> � � �n <br /> O W O I <br /> � N N � - <br /> ro � � Tp �ncTING. __��-I �l '' <br /> � � Sewer Application and Permit ' � E <br /> � � <br /> N <br /> N <br /> N <br /> � °� y � � 3 7 �� DATE —' " -- <br /> ,.;,., � <br /> � � , �, , ,- �, ,..- <br /> Service Address — Utility Account No. -- <br /> 8illing Address " � — <br /> City,State,Zip 'yernee �r� m�� �� Permit Fee $ __ <br /> Owner 'r��.. :.lbritton Connection Charge <br /> Conneclion by �"�" �'lu[obin� . Drain �l�a�±.r�.� Trunk $ <br /> Address �-�"� "C�""�� ��v�• Lateral $ <br /> _•vcrnr.t, �an '+��zoi TotalConnectionCharge $ <br /> � " Phone _"' -77"` Ulility Development Fee <br /> I ��' - <br /> Legal Descr�ption: Water S <br /> 1 '.,,� Lot —_ -- Sewer $ <br /> ��I Block --_ Total Development Fee $ — <br /> Plat <br /> � � <br /> � ��� Unplatted Doscrlption: _ _ Sewer Bond Disirict <br /> Abutting Lot Line <br /> �� n. <br /> � -- — N� S, E� W <br /> Type of Perrnit "'�i'�,Z^ Approved By — <br /> � ��1 ' Remarks _ IssuedBy ' ' ,-:���'it (, <br /> � ;>r <br /> ___ Customer SlgnaWre ''� '' <br /> i <br /> �� 1.�' ' IMPORTANTI <br /> Cl�,.f., 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> Inspection By �_`''�""" <br /> CALL 258•8810 FOR INSPECTION <br /> Date Inspec�ed !� ^� y � 2 -- <br /> SEE SKETCH ATTACHED <br /> INSPECTION '� 'r� Y � I <br /> � <br /> I <br />