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. . <br /> --�,_ - - _ - <br /> _ _ _ ,. <br /> CHART NO. <br /> y�,� ' TO POSTitJG__ -� <br /> x r •. <br /> ��H <br /> � �w <br /> 9 H(n � �� ,;, � <br /> , ., - <br /> H �I-�-I � . '.n .a � ; <br /> � `'� Sewer Application and Permit <br /> � �, -w <br /> � H� ; ,.. � _ <br /> �nH - � ,_,' �- : <br /> yt" . , �'-' ��� " - <br /> z <br /> E� y� n ,�� " . DATE _„s — <br /> ��g , ",'! " :'�i- �`•: Utility Account No. <br /> Service Address <br /> '�" H�'j •il l ! :11nt Avr 1:E <br /> �., H y Billing Address <br /> g v'H City, State,Zip <br /> �,r•�nville t�A 98271 permitFee $ ��•��`� <br /> � �� Owner :°���d 1Gilnr.qul �. ConnectionCharge <br /> z H cn ;;-a r Trunk $ 'r.7�.0(1 <br /> �3 o cn Connection by <br /> Address <br /> Lateral g asc.no <br /> �;:n,on <br /> Totai Connection Charge $ <br /> Phone �''"-�� � _ Uliliry Development Fee <br /> �"' b Legal Description: <br /> Water � t'�.cU <br /> �� $ 471.OD <br /> Lot �" • ��r� ---- Sewer <br /> '... � ,,� ,in<•t�urnc TotalDevelapmentFee $ 55��'�� <br /> � Btock <br /> �. � <br /> Plat <br /> Unplaried Description: Sewer Bond Dislrict <br /> � � Aburiing Lo' Line <br /> (+ N,S, E,W h' <br /> � � <br /> TypeofPermit ����' �'�r.nrcc:��� _ ApprovedBy , <br /> Issued By ��E� <br /> _.,,. 1 Remarks / <br /> Customer Signature '� <br /> — - • <br /> �—. � IMPORTANT! <br /> CALL 1-500-424-5555 48-HOURS <br /> PRIOR TO DIGGING /' / <br /> InspectionBy � ���� r�"" <br /> `� CALL 259-8810 FOR INSPECTION � _ � �_�, 3 <br /> Dale Inspected <br /> SEE SKEI'CH ATTACHED _ ?R� 3�' <br /> INSPECTION <br />