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CHART NO. — - — <br /> � TO POSTING_!����. <br /> �t�7y <br /> ID�S <br /> ta" yy ' LJ� �1� �' ��. . <br /> y �� � C� : , _ -_ . . <br /> � ~� ' Sewer Application and Permit '�'� ° ' i9s� � t <br /> yH <br /> � z� .. :�TY " _. <br /> pj.id ) � ^ . ' L/7/5, eUildin� tl�Eh�. <br /> DATE _ <br /> H �g , -------- ,,.. <br /> �Y �] <br /> �+ � i�7.5 Cndy l:d Utilit Account No. � <br /> x y� Service Address y � <br /> � r+H Billing Address ���1°�A"a � <br /> gy~ + ��� L401II PermitFee S _ 71� ��� <br /> C vr City, Stete.Zip .y:-.w:::.:.—..— " <br /> � �y Owner ���onveaith Conet ConnectionCharge <br /> yov, (t\"`•- <br /> Cornection by Trunk a <br /> Address — Laieral S <br /> � __ Total Conneclion Charge $ __ �'��� <br /> � � I <br /> Phone — Utility Development Fee <br /> ��� I LegalDescription: Water $ 26L90 <br /> ' Sewer y_ F48•00 <br /> Lot _ <br /> (` �� Block — Total Development Fee $ 949 00 <br /> Plat _ — <br /> ! ' Unplattad Description: Sewer Bond Disirict — <br /> Abut�ing Lot Line <br /> I `i — N.S, E,W — ft. <br /> Type o�Perml� Nev conrtructlon Approved By _ <br /> �� P � � CIl �� <br /> ~ Remarks _—_ Issued By <br /> __ _ ________ _ Customer SignaWre <br /> � �� <br /> ' IMPORTANTI <br /> ' CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING ,i <br /> Inspectlon B —y'" �" ! " �'— <br /> CALL 259-8810 FOR INSPECTION , � � , _ �_ <br /> Date Inspected <br /> SEE SKETCH ATTACHED - , � o <br /> � INSP.-:C-IION � � <br />