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� ��U':� <br /> •� � �«� <br /> . . � �:,L:.. . � <br /> � CHART NO. <br /> ��� ��0 �s-�-�i� , <br /> �i�i� <br /> ay <br /> ,oxx ; <br /> 9 H tp <br /> o �o I Sewer Application and Permit <br /> '� f~/1 F�-� I <br /> � o� � .^ 28353 DATE �-/z - 9Z� <br /> H C7 I I <br /> � � Service Address — Ut;lity Account No. j <br /> H �g <br /> "" � Z 7/g!3a <br /> z H , Billing Address <br /> H� <br /> � H y ' City, State,Zip Permit Fee $ i <br /> gN , <br /> � d y ! Owner / ./�c Connection Charge I <br /> � �r I Connection by dT � U P�t e // Trunk $ <br /> zy� ' <br /> y ��' Address Le:eral $ <br /> � � <br /> j Total Connecfion Charge $ <br /> � Phone Utility Development Fee � <br /> �� Legal Description: Water $ ! <br /> �I��� I <br /> � ' Lot Sewer $ i <br /> I ' Block Total Development Fee b <br /> �� � <br /> ""� Plat <br /> (,,,,� � Unplatted Descriplion: Sewer Bond District <br /> "�� II Abutting Lot Line <br /> I I <br /> ! � N,S, E,W n. <br /> i � � li Type of Permit /«P�/ti' �y /1 ls���=r✓ APProved By ' <br /> � , / , �/ <br /> �-� ... � Remarks � : dL -� . ,r k� - �. , z�?�r� Issued By ' <br /> '�' �� �� ,O� i�'/" �✓C Cuslomer Signature <br /> ���'�� I; IMPORTANT! � �'�6 �/ � �'/L <br /> '' CALL 1-800-424-5555 48-HOURS � �� � °7� "�'`� � C� ��� I <br /> � ' PRIOR TO DIGGING ' <br /> CALL 259-8810 FOR INSPECTION Inspection By�3. � <br /> ��I Date Inspected �� �j � �� <br /> SEE SKETCH ATTACHED � <br /> UTILITY BILLING i'° 2 ii 8 5 3 <br />