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Sewer Application and Permit <br />DATE 1 t-z7-94 <br />2953- � <br />-• � <br />Service Address 6806 Herkshire <br />Billing Address <br />City, State, Zip <br />Owner Todd McNeal <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />alteration <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-WO FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART NO <br />T" pntTING aza.9�l <br />Permit Fee $ 30.00 <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Tctal Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />— Issued By <br />— Customer Signature <br />Inspection By <br />Date Inspected <br />INSPECTION <br />29631 <br />III <br />