Laserfiche WebLink
0.hJe.:'�ar"�'�F}�.«�SJ,�;+c�iri .��...._�'�°'ri�ei�:. ,>+�: ; _� •;+�: ,.�;;'c�r <br />CHART NO. <br />TO POSTiNG �i L3-� <br />r, r <br />" i r. Ca i -. <br />' I � �"� f� t � <br />G i I. e � � <br />r - . + <br />• • �� • :" <br />Sewer Application�,and^ P_��rni#�, �, ` <br />O C�Gib%.(� u) 7> "' Jr-- ` t <br />`•, C.r i J W J _ J=' '? St �� <br />:tC L. f�. .:' . : 'ii .j �i 7� _. _ . <br />- .: ?A7��1 DATE i,-%J7-%{ <br />Service Address ___LY� �/, �'('J�'J'Jl1 �I/,�( _ Utiiity Account No. <br />Billing Ai <br />City, Sta <br />Owner <br />Connection by <br />Address <br />Phone _ <br />Legal Description: /� <br />Lot �% � �" �.�'� - / - <br />Block <br />Plat <br />Unpiatted Description: <br />Type oi Permit ,%%O/i )�('i)'1 � 7/ar/ I�iYZJ <br />Hemarks <br />IMPOFfTANT! <br />CALL 1-800-424-5:i55 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-881� F�OR INSPECTION <br />�-: <br />tjl <br />f.] <br />Permit Fee $ ��' U� <br />Connection Charge <br />Trunk <br />Lateral <br />$ <br />$ <br />Total Connection Charge $ � — <br />Utility i3aveiopment Fee <br />water $ 22� C( <br />Sewer S - <br />� ���1.� <br />Total Development Fee $ ����' �� <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By Q�J <br />Customer Signature <br />� � <br />Inspection By �' 1��� �A" <br />Date Inspected 'l�- 30 - '�'j � <br />SEE SKETCH ATTACHED r_u �, � 7 8 � <br />INSPECTIUN � <br />ft. <br />