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[5'''°"���??'v0["��sa';"s�'_tc' �....--r, .�1 —�-- :}�.a _i A.. . ..-.a,.iY�i.! i.. , . .,. . 't .. .. . . . .. . ... . . .. . �ti . <br /> i <br /> � CHART N0. <br /> i <br /> � <br /> i <br /> I <br /> � <br /> I I <br /> � � <br /> i I <br /> i T� pr�cTlNG �>-zq-�� � <br /> Sewer Application and Permit <br /> . 2 9 3 31 DATE 7/B/93 <br /> Service Address 4016 !liday Ave Utility Account No. <br /> Billing Address Sama <br /> City, State,Zip �..r..rr we 48�,f 11 Permit Fee $ 30.00 <br /> Owner �eH 6 Troy Bean Connection Charge <br /> iConnection by Trunk $ <br /> , Address Lateral $ <br /> i Total Connection Charge 0$ <br /> U�/ / `• 1�J. ' �N 4YS ni�+�l: <br /> � Phone _ Utiliry Development Fee ' <br /> HOOC29�'t <br /> Legai Description: Water :'�Et��? i;O.t70 <br /> C4ECl; sSD.� <br /> Lot Sewer $ <br /> i Block Total Development Fee $ <br /> i <br /> � Plat <br /> Unplatted Description: Sewer Bond District <br /> i Abutting Lot Lfne � <br /> I <br /> i <br /> N, S, E,W ft. <br /> I Type of Permit x°p41r Approved By <br /> � Remarks Issued By � Bb '� <br /> ~�—�-� / <br /> � Customer Signature� ' � � '�� � � ��� <br /> � IMPORTANT! ���f <br /> I �� ! �5�„f(� <br /> . CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING `U`� <br /> IInspection By <br /> CALL 259-8610 FOR INSPECTION <br /> � Date Inspected <br /> I <br /> � <br /> I SEE SKETCH ATTACHED <br /> iINSPECTION Z 9 3 3 � <br /> — --- - - -- - <br />