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,. <br /> CHART NO. — <br /> �:,, <br /> Sewer Appiication and F'ermit <br /> DATE i o - � 9 - 9 s <br /> Service Address � � � 8 �--! '`f C-��So'v Utility Account No. <br /> Billing Address <br /> City, State,Zip Permit Fee � <br /> Owner — Connection Charge <br /> Connection by � Trunk `� <br /> Address — Lateral $ <br /> Total Connection Charge $ <br /> Phone Uti�ity Development Fee <br /> Legal Description: Wai2� � <br /> Lot Sewer � <br /> Block Tota� Development Fee S <br /> Plat <br /> Unpiatted Description: �/L � Sewer Bond District <br /> � " S '�SQ �p �_��^ ^'� � Abutting Lot Line <br /> 7b � � S, E, 'N .--- ft. <br /> C . ra � �LL4,.v _ N, <br /> � <br /> Type of Permit C � /��- -� ApProved By <br /> Remarks L�f ti-' � � � � Issued By <br /> / 3 �'j ' L oj /iq Kr - Cuslomer Signature <br /> IMPORTANT! <br /> CALL 7-SQO-424-5555 48-HOURS <br /> PRIOR TO DIGGING /�, nc� QO� <br /> Inspection By �`� �- <br /> CALL 259-8810 FOR INSPECTION �o � 9 _ G � <br /> Date Inspected <br /> � SEE S�ETCH ATfACHED <br /> CUSTOMEF COPY <br /> ewo, <br />