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_� � <br /> - - - _ _ .-- -- _ _.-- ------- - - -- <br /> � <br /> �---- - _ <br /> � -- CHART N0. <br /> �in� . - <br /> m�� { TO POSTING �-= ' <br /> rx� <br /> K �� � Sewer Application and Permit , ; <br /> � , <br /> '� H�+7 . ,. _.} : <br /> � z� ? 9 0 ^:' DATE 1-� l-�= , <br /> 0 <br /> HG ;. ,, r <br /> o i-, 5605 r.rr. e��n ,a�•� Utilit Account No. � <br /> Service Address Y i <br /> H �,g � <br /> H" � I Billing Address <br /> zH� � <br /> �.a, '�z Ciry,State, Zip I•.`1r.TG•tt t;n 93201 PermitFee $ I�•�� ' <br /> c <br /> gyH Owner Sce:e Klein ConnectionCharge � <br /> I <br /> c� C7 t� � <br /> � �r Connection by Trunk $ ! <br /> z �7c�ii �505 Fver.•,r'"'n t<.:v Lateral $ <br /> y c-�cn Address <br /> i <br /> Total Connection Charge $ j <br /> Phone 35i-i 500 Utiliry Development Fee ' <br /> t <br /> � Legal Description: Water $ f <br /> ...„� <br /> Lot Sewer $ � <br /> !� Block Total Development Fee $ ; <br /> ,� Plat ' <br /> ;"� Unpl2tted Descriptlon: Sewer Band District � <br /> i <br /> '�y _ Abutting Lot Llne � <br /> �� <br /> �� N�S, E�W .. ft• <br /> 'a.. „� Type ot Permit ��lP af£ Approved By <br /> ��" Remarks Issued By i�`'' _ . ' � I <br /> i `� , <br /> '.o.� I ___ Customer Slgnature �I,'� !� �`"'� � � � �� I <br /> 4�t <br /> IMPORTANT! <br /> '+ w' <br /> -.,.,,, CALL 1-500-424-5555 48-HOURS � <br /> PRIOR TO DIGGING / a/ _ _ <br /> Inspection By / 'r!l <br /> CALL 259-8810 FOR INSPECTION 1 r_ 9-3 <br /> Date Inspected �- I <br /> I SEE SKETCH ATTACHED <br /> INSPECTION - �9� �z I <br /> I ' <br /> - --- -------- <br /> I <br />