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r�+'�ly�-4v�r-�.-��.}..��..�,�. . <br /> , . . . . .. . . . . . , . . . q�dvy,!'to'r..,�.rrcrn�y.,,.�y,��p�,.p��- ..-.-,..-.,.-"1 <br /> CHART N0. --_ � <br /> � <br /> - I <br /> i � � TO t�(lcT�ti!r, � �� •,—���� , <br /> , � :� �� s _ <br /> i ; `.�' �' � - - i <br /> �, � . .'; .,� ' . <br /> , , <br /> � Sewer Application ar�;d Per�nit, _� ! � <br /> � - �? ,:; L, ;� ;� ;; �;� . I , <br /> ' �:: <br /> . ?, 97 '3 DATE i ;j ;�� j %4/� a, r;� -� j <br /> I <br /> � , .- ; ' � i <br /> � 3ervice Address •="� �-� � ��'1 � i5�� Utflity Account No. � <br /> � [3illing A;Jdress ���C � ��- � <br /> � City, State,Zip _!✓�C� Permit Fee $ �(� ,�; I <br /> I Owner �//� � %� � ��, '�� Connectlon Charge j <br /> � , <br /> � Connection by Trunk a � <br /> � <br /> � <br /> Address Lateral $ i <br /> I ! <br /> — Total Connection Charge $ �' � <br /> � Phone Utility Developmem Fee � <br /> I <br /> � Legal Description: Weter a % ��- <br /> �' /f I <br /> I Lot �=- V� / 7�l Sewer a ����- ' <br /> i <br /> iBlock Total DevelopmeM Fee a li'.1�� � <br /> ' Plet ; I <br /> Unpletted Descdption: Sewer Bond Disttict ; II <br /> i Abuttinp Lot Line ; <br /> � N�S� E�W ft. i ' <br /> � i <br /> � Type of Permit �G��L��)� I)� �r)L, Approved By __ ; I <br /> Remerks � <br /> � Iasued By � I I <br /> � Customer Slgnature ! <br /> IMPORTANTI ' <br /> i <br /> CALL 1-800-424-5555 48-HOURS � <br /> PRIOR TO DIGGING � Y� /7 ; i <br /> / ' <br /> CALL 259-6810 FOR INSPECTION Ins ction e � I I <br /> Date Inapected /�• 7 • �y I <br /> I <br /> SEE SKETCH ATTACHED ' <br /> INSPFCTION Z ^�2 3 i <br />