Laserfiche WebLink
�----- - - -- --- - - <br /> ----- ------- <br /> ' CHART NQ. <br /> �, <br /> � � <br /> 'i - __ . , , A� POSTING � - z- i <br /> , . I , <br /> � Se�nrer .4pplic�ti�n and Permit !, <br /> ' , � r•r; ...!� DATE '2 7'�y �I <br /> , <br /> � �.�. ���' � <br /> Service Address ' ' Utiiity Account No. <br /> i <br /> Billin�Address �(� � / / <br /> �/ � , / � <br /> �j t J�' 7� 2�/�1 Permit Fee $ �)� ((� ' <br /> City, State, Zip �-----r / I <br /> ' <br /> Owner '''� f�»an� '��l�'���1 G!i � Connectlon Charge <br /> Gonnection by _ <br /> � Trunk $ ! <br /> Address Lateral $ I <br /> Totai Connection Charge $ � � <br /> Phone Utility Development Fee <br /> . <br /> Water $ -� <br /> �egal Description: /, �� f � <br /> Lot / <br /> Sewer $ <br /> � _ Total Development Fee $ ' "� /� ' /� - <br /> Block --- <br /> Plat II <br /> i <br /> Unplatted Desciiption: _. Sewer Bond District ', <br /> '� Abutting Lot Line <br /> � NSEW ft. <br /> I i <br /> Type ot PRrmit `' ��"� " ' � 11' �/t' - Approved By <br /> 1� Remarks �7�� ��-���'�l��`'—�= ���� �ssued By � <br /> �, �, � �� � �' ��i�r� ��Y ���� ��"� .�- Customer Slgnature � I <br /> ' ,_�:1�J-C � <br /> i IF+APORTANTI I <br /> � CALL 1-�00-424-5555 48-HOURS '� <br /> ! PRIOR TO DIGGING � -- <br /> Inspection y �� <br /> CALL 259-8810 FOR INSPECTION Date Inspected <br /> � <br /> �, SEE SKETCti ATTACHEU � r;v 2.' � <br /> INSPECTION <br /> __ _ _ _ _ _ <br /> ..}':i' ..___. . _. . <br /> _ � .� e.�. . 1 <br /> ..A�-��i�i, <br />