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. . .;'FTZ[i�*'fnc�•-�e �i',--Ttzr.T^".,i"T'-c. . . „ .. - . _. . _ <br /> CHART NO. --_— <br /> � <br /> iTQ PQSTIRG-�2 21-43 <br /> �.`�,. <br /> Sewer Application and Permit ,,������ I <br /> � ;r�. .. . 19g3 � <br /> 7.3037 oAre l-/9-93 oR �� . <br /> ��;�� � ry� Olvl�RFtT... � <br /> Service AdOress _.�LL_(,.�� ' Utiliry Accounl No. °� �i <br /> BIIIIrpIWdrl6s � Rnx 52h7 <br /> CIty,State,Zip Eo"rect uA �8206 PermitFee $ 77.D0 w � <br /> � I <br /> p��. • e sH�ed � ConnectionCharpe � <br /> Connectlon by Tmnk S� <br /> q���e Lateral 5 <br /> Totel Connection Cherpe E <br /> phone _ Utility Development Fee <br /> lepel Deecription: Wa1er S <br /> �� Sewer S� <br /> g� Tota�Oevek?ment Fee 5 <br /> Plet _ <br /> Urqletted Deecriptbn: Sewer BonC Dlslrid <br /> _ Abuttinp Lot Line <br /> N,5.E,W n. <br /> Type of Permit Cavroff Approved By � <br /> flBi78fk8 �65UBUBY � �� „ /� <br /> � . .. ,t`.�fyrfl <br /> Cuelomer Sipneture �� '� '� Lv—�''� I <br /> IMPORTANTI p�v � �� 3�cc�•�„' I <br /> /� I <br /> CALL 1-800�24-5555 48•HOURS �j �j�{,. I <br /> PHIOR TO DIGGING <br /> CAIL 259-8010 FOR INSPECTION �"�bn By — c � <br /> Date Inspected <br /> SEE SKETCH ATTACHED 2 9� 3� <br /> INSPECTION - <br />