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��. . • . i . � .. � . u. . . .�. ... <br /> ' � =-` CHART N0. <br /> � ' <br /> ., <br /> � <br /> � <br /> � p o ppp pT^ �esr�Nc 3-3�93 ; <br /> Y: o s G CJ Iri s O G � p g •_---- � <br /> � c c-'�-' o '� ' a e `S'� c-'.� . o o.y'� I <br /> � �-1 � � �/7 N� M f(� l4 �. <br /> (�1 Y. W M y� -.y <br /> Sewer Applicatio� � �4 c�� � it � � - � � l <br /> r <br /> � � � � <br /> � I <br /> � �. 7 a 9 2 � � � 9/28/92 $ a u <br /> DATE <br /> r_ i <br /> Service Address 5�2� P�rk°1�w L° Utility Account No. �� i <br /> BllflnqAddress 16i10 e.�-a.d A � <br /> City,Stete,Zip - *��+asu� li� 98pp.7 Permit Fee $ _ 70.00 <br /> p�� 6�i4-2323 Connection Charge <br /> Connection by � �- � Trunk $ <br /> Address Lateral S * <br /> TotalConnectionCharge S �•� <br /> � Phone Utility Development Fee I <br /> � Lepa Oex�iptlon: Water a 179.00 <br /> Lot �8 Sewer S <br /> B� Total Development Fee � 179.00 <br /> Plat p..+.e+�k <br /> � <br /> Unplatled Descriptlon: Sewer Bond Dist�ict i <br /> _ Abuttfng Lot Line ' <br /> i <br /> N,S, E,W ft. ( <br /> Type of Permft 1Me eoanaceion Approved By <br /> � <br /> Remarks Issued By GS +{ <br /> Customer Signat�re �` `-� ` � �- ' '-1���-�� �`- ,' ! <br /> i <br /> IMPORTANTI I <br /> CALL 1-800-424-5555 48-HOURS i <br /> PRIOR TO DIGGING i <br /> CALL 259-8810 FOR INSPECTION Inspection By - ��r �dti'y � <br /> , . Dflte Inspected �� a r''� Z I <br /> i <br /> I <br /> SEE SKETCN ATTACHED � <br /> INSPECTION � .`_' 2 8 9 2 t i <br />