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mix <br />ayW <br />HRH <br />y 7H <br />r3 W <br />xx VJH <br />tf 05 <br />�3 t 7 <br />H � gqg <br />9 H Cif <br />C H H <br />C N <br />O H <br />o C ti <br />CC <br />� trst <br />z y cn <br />Sewer Application and Permit <br />"E 29294 DATE— 2- 93 <br />Service Address a r � pI A Utility Account No. <br />Billing Address <br />City, State, Zip Permit Fee $ <br />Owner Connection Charge <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot %I' rT l oy „vc 5'g. e <br />Block ID(P-�,. b ��e <br />Plat C/ddgr) A+ r S�mQ <br />Unplatted Description: / - Pf-41- Pyre <br />P27 en <br />Type of Permit �O /b4e2 <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />N. S. E, W ft. <br />Approved By <br />Issued By_ <br />Customer Signature <br />Inspection ByG•����/�-� <br />Date Inspected —,7 '�d� 53 <br />UTILITY BILLING <br />i'- 29294 <br />