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_ . _ _._ : : . , , - <br /> :,. .. . - . � __._ . <br /> � , ,�� <br /> CHART N0. <br /> r `' M• �.:^ ,_. . <br /> � ;�'� �_: _ `CQ POSTING 12-''-g� <br /> _� - -� — <br /> ..�` .+ .r _� n � ^ <br /> .n�t,.`.V_u/' - <br /> ,r <br /> .._ ';�:, :. ,j .-i • <br /> S�wer Applica'.t;i:on,-and P�rrnit <br /> � `� 2 7�y <br /> � 29r %� ~ DA7�^ � <br /> , ��� a7 <br /> Service Address � Utility Account No. <br /> Billing Address —��U� 2-----y"i— /t ; <br /> �,�-%, 9ifn2�� PermitFee S ���� C�� <br /> City, State, Zi� �----- <br /> Owner � ��� �����J �/�'�"'� Connection Charge <br /> �� � <br /> Connection by Trunk <br /> Address Lateral $ <br /> Total G nnection Charge $ ''1 <br /> Phone Utility Development Fee <br /> Legal Description: Water $ � <br /> Lot _ — <br /> Sewer $ i i //J• G?i <br /> Block <br /> Total Development Fee $ ��'��� <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> A6utting Lot Line <br /> NSEW ft. <br /> ',:,� iype of Permit ��f�/i ' �'//Y�M����li'�rr � Approved By <br />�� �tiemarks �7`���Q �����/���''/�� ��r. IssuedBy <br />� ,� ��f� ����l��/.y ////�.V �,l%/1 [�� Customer Signature <br /> �,� f' �-�a-� <br />„ k�I IMPORTANT! <br />�� CALL 1-800•424-5555 48-HqURS � <br />�; PRIOR TO DIGGING / <br />�,x.� Inspection By l <br /> , . , CALL 259-8810 FOR INSPEGTION �. • _ <br /> Date Inspected <br />:;a:�-�; <br /> r-;•�;'�_i . <br />� . <br /> „ . <br /> '��; SEE SKETCH ATTACHED , � <br /> �3; � i-7IT'; f?IILWG. <br />�,. - — ;� <br />,�� .. ___ ' �,. ,. <br />� �� � <br /> -7 � .. ��. . ..� <br />�'y���,. <br /> 13- <br /> 1 <br /> t�— . . ���ea..'�,.� . . AT�hvi"d�.t ,,.,.v . <br />