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.r : __�.v.�___� <br /> . _. , .. . � �3�7k , • .. , . , . ,. . . II <br /> � f . `, . , . . � I <br /> CHART N0. <br /> ,� � II � <br /> � "� ��STINGq1C�15� <br /> �3� �1 p p p Q p p p <br /> � p G� Ob 1.!� 1� r1 � O G C] (1 <br /> V r. )� O O •f tl �Q � G L7 O .-! <br /> N [- �ll Cr. ' M GI M [- C�l b� CJ <br /> � y� yy N �I1 a� � M O DJ <br /> � C:� fl� W I <br /> Sewer Applica�o� anc�P �iy]tc � � <br /> �+ LJ J �++, �-� .�-� <br /> (� v 1 � c.�] N R' _J Q � �!'� _.rs Cy � <br /> 29750 � � � � �%7 �� � � �' � �; <br /> ` " DATE <br /> Service Address ��J ���� tflity Accowt No. <br /> Billirg Address Z <br /> Cgy� State�Z�P Permit Fee $ Z . )Q <br /> Owner 1 ��l�r�- V�LL— Connection Charge �I <br /> Connection by Trunk s 33D.00 <br /> A�� Lateral $ ��^�� <br /> Total Connection Charge $ � -��� <br /> Phone Utility Development Fee <br /> Lepal Deacription: Water $ �79.U� <br /> �t 2 `S,� 2 7-9� sewer s �7/. �U <br /> B� Total Development Fee s 1050•� <br /> Plat <br /> Unplatted Descripdon: Sewer Bond Distrfct � <br /> Abutting Lot Line <br /> N,S, E,W �• <br /> Type of Permit �.l� J �lh 1.1�P��1['e�_.L Approved By <br /> Remerks Issued By � <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> Inspection B <br /> CALL 259-8810 FOR INSPECTION � <br /> Date Inspected �2 �5 <br /> SEE SKETCIi ATTACHED , � 2 9 7 5 Q <br /> INSPEGTION • •�• <br /> ------- --- — <br /> ----- - -------- <br /> --- -- - <br />