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CHART NO. <br /> S C"'ii <br /> �'a� <br /> ro�s <br /> C H <br /> >HN <br /> rw <br /> y �� Sewer �pplication and Permit � <br /> K y� <br /> � H� <br /> NH <br /> �, o� i :'_ 29280 DATE �' 7- � �- 93 <br /> HO <br /> "�� �g Service Address 3 ��0 ���w� Utility Account No. <br /> n� c� <br /> ay� Billing Address <br /> r y.x3 City, State, Zip Permit Fee 5 <br /> gd� Owner Connection Charge <br /> Z y N Connection by Trunk $ <br /> H O f/� <br /> Address Lateral $ <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> C] Lot L'�,F�(.4cOft �� el ��M4 ,. / Sewer $ <br /> BIoc1:'�un TXF C o.✓ irt.� . / To;al Cevelopment Fee s <br /> �� Plat cA. �. _5 '�I2 S� „a2 � 7d <br /> Unptaned Des.ription:P�L �� � l 3 n Sewer Bond Disirict <br /> �� /� / <br /> ��� [.�lLaA�� ��i0' �Q� �� Abutting Loi Line <br /> 3�_�� �s ,�y3� I� � �a (� 33r( N,s, e.w n. <br /> 1�� ` <br /> �� Type ol Permit o�,p�p 9 �S �7�R ' .V [7/ /�1N Approved By <br /> 3�-f '-- <br /> Remarks@ Issued8y�� ! .rl�s� <br /> �— .-,-,�,,,,. i 9 '�-l. s P5 G � �/. � <br /> Customer Signature _ <br /> '� IMPORTAIJT! <br /> �� <br /> CALL 1-800-424-5555 48-HOURS <br /> - PRIOR TO DIGGING �t <br /> CALL 259-8810 FOR INSPECTION Inspection By ( �� � ���--� X-�- <br /> Datelnspeded 7' � R' 9� / <br /> SEE SKETCH ATTACHED <br /> UTILIN BILLING i`�:° 2 9 2 8 Q <br />