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��5 <br /> O�.�yC <br /> ',�yHtA <br /> H�� —._ _ _ _ - --- <br /> , � <br /> Q��� ` f CHART NO. <br /> Hy : I <br /> o�� __ S-zc-q3 ',� <br /> TO P�ISTING <br /> ��8 <br /> t"y� : J <br /> c i <br /> I <br /> �yy i Sewer ApplicatiQr� :and Permit j <br /> �� � � <br /> ; � <br /> ��in 2 8 9 7 5 1� DATE �,hovamtbz �1, 1�Q^ li <br /> i <br /> Service Address 2115 raciEic Ave. Utility Account No. � <br /> Billing Address 14615 h� 19oth st � <br /> Ciry, State,Zip D1oodlnVilln lPA 9son Permit Fee $ 70.00 ' <br /> Owner �lumbia, raint Connection Charge I <br /> � <br /> Connection by �QY Trunk $ ! <br /> Address Lateral $ �� <br /> Total Connection Charge $ '�' � <br /> ��� Phone Utiiity Development Fee j <br /> '�' Legal Description: Water $ I <br /> � ' �ot Sewer $ <br /> ��' Block Total Development Fee S -� <br /> f�1 Plat <br /> ��� Unplatted Description:, Sewer Bond District " <br /> ' Abutting Lot Line <br /> ' N�S� E�W �1• <br /> � Type of Permit N�' covtrccrzott qpproved By_ <br /> 1 Remarks Issued By � �ekwrell <br /> ' � ' <br /> �1 CustomerSignature -A� �� - "l"-s^ "'� <br /> �' IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> i Inspection B�� ' <br /> CALL 259-8810 FOR INSPECTION <br /> I Date Inspecled 3�'-*� <br /> SEE SKETCH ATTACHED <br /> INSPECTION '. 2"��� <br /> I <br />