Laserfiche WebLink
--- -. -,.- -- - -- ---- --------- -- -- . .--- -- -- - --- - <br /> ., � <br /> CHAF;T NO. -- <br /> Sewer Application and Permit <br /> 7�'S�5 DATE l]/'.:;J'�; <br /> 140: 4:oar:utl� <br /> Service Address Utility Account Na. <br /> Billing Address 1&31 c;olUy <br /> City,State,Zip I.verete ��A YBZoi permitFee $ ���'���'_ <br /> Owner � n„ noL.i�«c Connection Charge <br /> Connection by Tmnk $ — <br /> Address Lateral $ <br /> Total Connection Charge $ <br /> Phone Utiliry Development Fee <br /> Legal Descripiion: Waier $ _ <br /> Lo� Sewer S <br /> Block Tota�Developnent Fee $— <br /> Plat . <br /> Unplatted Descnplion: Sewer Bond District <br /> Abutting Lot Line <br /> -- N�S�E�W R. <br /> Type ol Perm7 /+lcernHan _ Approved By <br /> Remarks _--. Issued By _ ��� <br /> ___ . . Customer Signature <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING � <br /> CALL 259-8810 FOR INSPEI:TION Inspection By <br /> Date L�spected � � <br /> SEE SKETCH ATTACFiED <br /> INSP[CTION ?�.' J•I� <br />