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��� <br />9H <br />rD�1S <br />C.' H <br />A H (/� <br />H � .i. <br />�x� <br />o xn <br />'� H'•. <br />NH <br />� O� <br />oHC <br />HMO <br />� V � <br />t� y � <br />yy <br />H <br />C] C7 y <br />� H t�/� <br />H O [n <br />� <br />CHART NO. — <br />TO POSTIPJG 6_�-gs <br />Sewer Application and Permi� <br />�� �` DATE <br />Service Address ----- <br />BillingAddress �`": 19ch 1�s <br />City,State,Zip _°kilcc+o wn 93275 <br />Owner _ '.I:red T Jubf�. <br />Connection by <br />Addrers <br />Phone _ "''�'�456 <br />Legal Description: <br />Lot <br />Block <br />Plat _ <br />Unplatted Descrip�lon: _ <br />TyPe01PBfRlll ",.w cnnr.�ctf,�n <br />Remarks = — — <br />IMPORTANTI <br />� CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />Utility Accoun� No. <br />PermitFee $ _ i0,���' <br />Connection Charge <br />Trunk $ — <br />La�eral $ - <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ U9.r��i <br />Sower S - <br />47I .i'�C' <br />Total Developmant Foe $ �'5�—�'�' <br />Sewer Bond Dis�rict — -- <br />Abutting Lot Line <br />N, S, E, W—_ _ n. <br />Approved By _—_ <br />Issued By — , _- <br />���r � � ,. <br />Customer Signature �� { �{/-�% <br />Inspedion Bp_-- • `-� " <br />Date Inspected _ �" ' � � 3 <br />SEE SKETCH ATTACHED <br />,r <br />iusi�t c i ior� � <br />