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� � <br />H <br />9�y <br />� H� <br />� M "�� <br />V1 M <br />H <br />xp <br />OHd�y <br />H L'�+7 O <br />� V �% <br />t" y � <br />HH <br />gy <br />�d� <br />t� <br />��� <br />!� s <br />a � <br />�11 <br />`.�. ... <br />.�. � <br />Sewer Application and Permit <br />ass77 <br />DATE li/25/�? <br />Service Address G51G Fle:�inn, Rd _ <br />Billing Address �� 921U Evorgreen wy t <br />Ciry, State, Zip Lveratt Nn 982U4 <br />Uwne� 0'Conoor h Oehler <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type oi Permit <br />Remarks _ <br />Lot 1 <br />SP �23-91 <br />Cep-oif. <br />IMPORTANT! <br />�,�.� I CALL 1-800-424-5555 48-HOURS <br />I PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />CHART N0. <br />TO POSTING__-5=�z�-�,� <br />Utility Account No. "' `'`• <br />_,;l i`Y; � � <br />, . . . / .. �'�J/ <br />" , I .11Q.(:Q''. <br />Permit Fee $ . � <br />;i;,;: _ . <br />Connection Charge , <br />Trunk $ <br />Lateral ¢ <br />Total Connection Charge � <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Aburiing Lot Line <br />N, S, E, W tt• <br />Approved By <br />Issued By <br />Customer Signature " <br />� fp����. <br />� ��IPGv �CG�Se <br />Inspectl n By <br />Date Inspected �! <br />SEE SKETCH ATTACHED <br />INSPECTION <br />2C977 <br />