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�O <br />a <br />.r <br />Sewer Application and �Perritj <br />�ca <br />2 97 ,; 4 DATE �% :3 -g <br />Service Address ��C�%�� Utility Account No. <br />Billing Address <br />City, State, Zip %,%2 (-) Y Permit Fee $ 7�,GD <br />Owner CSC G C ///li) )�.�I1n Connection Charge <br />Connecti •,. by <br />Address <br />Phone <br />Legal Description: I r <br />Lot 49 <br />Block <br />Plat <br />Unplatted Description: <br />Trunk <br />a <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 <br />Type of Permit %1.�. ; lGyf}�: �irlL ;approved By <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECiION <br />SEE SKETCH ATTACHED <br />Issued By <br />Customer Signature <br />$7/.//:_ <br />$ <br />ft. <br />Covthe ° �T ° <br />Inspection By <br />Date Insp _ <br />INSPECTION <br />' i473q, <br />