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�, a-�: _ . . _ . ._:. __" c _. ._ . � .� , ..T. - w.r . Z_ _ ' _ ._ __ " .:'-' ' _� _ _ . ' r.'. <br /> i: . �:.u..t:;.�.�,hy�, .,,,> <br /> CHART NO. --�-_- <br /> � <br /> - �f) BUSTING ( "�.." <br /> �. - r_� _ ; r; '_ = G'.c._..—.' . <br /> �� r � <br /> jl r r^ u 't � : � - <br /> L' � J .0 <br /> . .-, .. ' `�� ' <br /> '�,, Sewer Application �and Per��t <br /> I � "� r � DATE " _ / � <br /> � �-..: - <br /> � � <br /> I '� �i� / � �' <br /> . n <br /> H / ! <br /> . �/ ��i� <br /> � <br /> ! Sernce Address � � � - ' � " ' ` " Utiliry Account No. <br /> ; Billinq P.ddress ��i% ���7 1 �; � /i'��� �' <br /> 7 � <br /> , , � � <br /> ' City, Siate, Zip r� ��'f� ���� �- Permit Fee $ - ' <br /> � Owner — � '� �� �� ',��/,> >'� � �' Connection Charge ' <br /> Connection by ri" ��, Trunk $ <br /> I Address - Lateral $ <br /> i � <br /> Total Connection Charge $ , <br /> I, Phone Utili?y Development Fee �� <br /> � Legal Description: Water $ �7'�" C'�-' <br /> Lot ��/ Sewer $ \ 7.�� l� �� <br /> ' Block Total Development Fee $ � / � '���� <br /> � ; <br /> Plat � / �� 'I' i /'�'I//. � , <br /> �i Unplatted Description: Sewer Bond District <br /> Abutting !nt Lir.e ' <br /> � N,S, E� �N ft' <br /> �� TYPe of Permit / ��U i '��,�J i �7i�'^T/:� 7� �' Approved By <br /> Rsmarks _ Issued By' ,� <br /> � <br /> ' Customer Signature <br /> fMPORTANT! <br /> CALL 1-800-g24-5555 48-HOl1RS , <br /> , PRIOR TO DIGGING C✓=' / <br /> Inspection By �� '���'� <br /> CALL 259-8810 FOR INSFECTION � �� yy <br /> , Date inspected <br /> SEE SKETCH ATTACHED � � � i <br /> INSPECTION � " �T '� " <br />