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F'-•.aP�-�-.-.��•:,,:�r.�.�;1f5P;,3VG«��tR,-.n �, n--�=,�b �:.� ,., �...-,� ��:�...-::.k:. c�3,:�':n..,...�r':. . 1�1`:.�:.�c�r?u.°+cxi^,�n.«�.. . . -°-- - _.._.. <br /> , . . r.tn . R c ..n.n�.�;.�- -�.�+x ,._ <br /> CHART NO. — <br /> .. pc� C, > . ; G � � C� i. .. <br /> :�_ NnJ [YI� Li C� Gi.� O �� <br /> " A � p � ` `; � � �' , L�'0 POSTING _ <br /> nr 7 :r� C.• Y r. <br /> r,i i;c <br /> ao ` .a � - F, <br /> Sewer Application� a�id P�rri�ifi; �; �, �` <br /> � <br /> 5� � -, � � � �-� <br /> �.-.� f�_'i � Gi f_t � �S rr'i_i � C� W � : �' <br /> � <br /> u ,� � w F " <br /> h 7:. G:5_ t � i] � r Sj: r�lL ' L'. <br /> 247 �16 DATE /ir'��I-��f <br /> Service Address /� /�r� /�1`�'L�[.y"I,f�!'L"Utility Account No. <br /> Billing Address �7�� r.)�Q�lL)'7.� �'"C <br /> � %C%,t�G <br /> City, State, Zip — � � Permit Fee $ <br /> Owner �--1�- �� �t !��r '] i Connection Charge <br /> Connection by Trunk $ ��'n• �'�� - <br /> Address — Lateral $ ���`'�'n <br /> Total Connection Charge $ /2JI G� <br /> Phone Utility Develooment Fee <br /> Legal Description: Water $ ��-�-�--+�-L— <br /> �ot � �—.,�t ���1 ) �/� i . ��� Sewer g �7�- GG� <br /> Block Total Development Fee $ L��' G�G' <br /> Plat <br /> Unplatted Description: Sewer Bond District - <br /> ' Abi�tting Lot Line <br /> NSEW ft. <br /> 1"ype of Permit 1',/�1� 1 i�/1 )hi ri/tl.� � � Approved By / <br /> Re�no,ks Issued By ���T� <br /> (. <br /> Customer Signature <br /> IlNPORTANTI <br /> CALL 1-80�-424-5555 48-HOURS <br /> PRIJR TO DIGGING �y`��'//�j <br /> Inspection By T�� — <br /> CALL 259-8810 FOR INSPECTION �_ � ,.� �_` <br /> Date Inspected <br /> � <br /> SEE SKETCH ATTACHED ,, �, ., � ,- <br /> INSPECTION `' ' ` " " <br />