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- _, ..---- <br /> - - -- -- <br /> _T._. - _ _ _- - ---� - <br /> CHART NO. ' <br /> I <br /> ��� ;i <br /> TO POSTING 7�z0 -qL� ; <br /> Sewer Application and Permit ! <br /> , � <br /> ' ? �? � � DATE r��_ - � - � %� � <br /> _ I <br /> Service Address �� '�' � � � � % Utility Account No. � �i <br /> +•',' <br /> Billing Address � a <br /> I , I �''i <br /> ! City, State,Zip Permit Fee $ - . �, ;� <br /> � Owner ��� ��` ' _ �' ; ���� ConnectionCharge � <br /> i I <br /> Connection by Trunk $ i ' <br /> I Address — Lateral $ i <br /> — Total Connection Charge $ j F <br /> ' Phona Utility Development Fee �i <br /> Legat Description: Water $ ! � <br /> Lot Sewer $ ' <br /> Block - Total Development Fee $ _ <br /> Plat <br /> Unplatted Description: _ Sewer Bond Disirict <br /> , Abutting Lot Line <br /> N� S, E�W ft. <br /> ! Type ai Permit \ - % � Approved By <br /> , / � / <br /> Remarks �����lQ' � �1� �� Issued By ' jJ�_� <br /> >P .�a,-, 5 � .� � <br /> Customer Signature_ <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> , PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION �nspection ey � !�w�' �� <br /> Date Inspected <br /> SEE SKETCH ATTACHED <br /> INSPECTION . �� �� ,� 4 '� <br /> _ _ <br />