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� � <br />Q�� <br />H�n <br />� <br />��� <br />(p H <br />yx <br />o�d <br />��g <br />QY �] <br />t"y� <br />��H <br />f~A <br />� <br />�a� <br />- <br />, �� <br />i <br />� <br />-. - - � __�_--. - -- <br />Sewer Application, and Permit, <br />� � ,_, - <br />�_� :� ' _ ,, _ <br />. .. ,_ _, ,� o : .. . _ <br />, 2 9 0:1i _ DATE . 1/27/43 . <br />Service Address ��306 Grand Ava <br />Billing Address 811'+ Hav., n�P <br />Ciry, State, Zip S* �^a �� �k�9Y <br />�y�ef ttichard Ken Sigelow <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />LOf 15 � 16 <br />Block 009 -- <br />PIBI Tarrarw A.IAn <br />Unplatted Description: <br />Type of Permit lJew connection <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHEO <br />Utility Account No. <br />Permit Fee $ <br />CHART NO. <br />Tp p�ST/N�` 9 7`S'j <br />\;� <br />Connection Charge <br />Trunk <br />Lateral <br />Totai Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />s <br />$ <br />$ <br />0.00 <br />$ 179.00 <br />g 471.40 <br />$ �sn.nn <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W n• <br />Approved By <br />Issued By � , , ^'� <br />�g ,. <br />/ , j��, �„1'4, � i <br />CrUS10tp8f Cfyn�r ro /i %'. <br />/ .. <br />Inspection By `n����""^'-` <br />Date Inspected ���3 <br />INSPECTION <br />��: 2��:4^ <br />u <br />�. <br />