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i <br /> ��L'VC.'� �.nnni ivv. <br /> �' '� j <br /> i i �: <br /> 11 , � ., <br /> � ,� ;.. ` . � • <br /> � _ C.., �J <br /> ::�tv n��ct , � <br /> =rci:�etec Q �bma�unity Services t' ,. <br /> Sew� Application and Permit " <br /> :.-; , <br /> N�. �_.I::' DATE � �'7- 7� " <br /> ='�"�="��'-'"`- ' , ('��. � �'`'- Utility Account No. <br /> F ' ,, <br /> 3;1i1���..-^�c;...-.--' ' .-":,- '✓ �� "U7 PermitFee jCJ Q�' <br /> � l � <br /> ` �' �� �G� Connection Charge(s) '���_ <br /> -�. i � <br /> � �;1•,�,,.�_ — � <br /> �'^� 'y-'^� " �� Total Fee___jv � <br /> �iilit¢7� " �-- <br /> I _ 1'" : <br /> .".Ji1if+T� -�-.:"' . ��..�� 1 <br /> I � � <br /> I / I <br /> =+�- � - -- Signed .�; .;. , _, ` <br /> � ` . �' '; `� �y Cusromer ` j <br /> � � <br /> 1 <br /> �=i— � '% <br /> � <br /> Sewer District ' � � f' <br /> � i i.. <br /> _IOCk � <br /> _S _ _ + <br /> _,- _ ��' — Monthly Sewer Service � . ->!J � <br /> '''``' � Monthly Sewer Constr. <br /> -y� _�: �' • .� . Trunk <br /> --- - -- Lateral <br /> y Abutting Lot Line y, --- <br /> � N. S, E, bV �/� • <br /> _ft. <br /> � <br /> ' / � <br /> Approved Bti� ` ��. �. <br /> Ciiy Engineer � <br /> : / <br /> , Issued By �^ - � ! <br /> �_ �i <br /> i <br /> 1 <br /> I <br /> I <br /> -.�_ Inspection By � <br /> _ - - Date Inspected � <br /> =SKETCH ATTACHED i <br /> INSPECTION N�• L 2 4 5 9 J <br /> � <br /> . � <br />