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C�CI{:ll <br />e � <br />� :� .: <br />ctey or E��ren ;� � <br />.i s ,: M k� <br />Sewer Application ar�d�e��mi� <br />_ �g�'sg.�e `� <br />� u A � U <br />NO. 28SSO DATE *- �- ,?- I°�- <br />SBNiCe AddrBss �c» e....w..,�. <br />BfllinpAcliress ' ""� -- — <br />Ciry, State, Zip T�--�__�__,--....�• �^ 9C�aG <br />Owner �--- <br />Connection by umer .— <br />Address — <br />Phone 258–+525 <br />Legel Description: <br />Lot -- <br />Block <br />Plat �q_ <br />Unplatled Description: <br />Type ol Pertnit 1�L7'aR1�'Pzola <br />Remarks <br />IMPORTANT! <br />CALL1-800-424-5555 46•HOURS <br />PRIOR TO DIGGING <br />CALL 259•8870 FOR INSPECTION <br />SEE SKETCN ATTACHED <br />Utili�y Acccunt No. <br />Permit Fee S <br />Tp pOSTING ��-- � <br />Connectlon Chargo <br />Trunk S <br />Lateral S <br />Total Cnnnection Charqe S <br />Uliliry Development Fee <br />Water S <br />Sewer S <br />Total Developmenl Fe�3 S <br />Sewer Dcnd Distnct _ <br />Abutling Lot Line <br />N, 5, E, W n. <br />ppproved By <br />Issued By _,� - <br />Customer Signature <br />e�a 1naerc�iait <br />��� �� C <br />Inspeclion By _ 8/�' i <br />Oate Inspen�ed <br />INSPECTION <br />No.285Fi0 <br />