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.�^� ..Y _.� � . � . � ,- . .:..4.• , � . . \ i.zti . ..:. .. , � ' I <br /> CHART NO. i <br /> TO POSTING C, -2��� ; <br /> � <br /> i <br /> ; <br /> Sewer Application and Permit � <br /> ': 2 9 713 DATE I <br /> � <br /> ) , <br /> Service Address �'���� � �' � t` `'�" ' Utfiity Account No. � <br /> � <br /> Billing Address j <br /> City, State, Zip Permit Fee $ �/ ' �-""`— � <br /> , <br /> . � <br /> Owner ��� �%� •� � ' `��j '' Connection Charge j <br /> � � : <br /> Connection by L ' /`-r��i ' '"- �' ` � Trunk S <br /> Addr�ss Lateral $ ; <br /> i <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Descriptlon: Water $ I <br /> Lot Sewer $ <br /> g�� Total Development Fee S I <br /> Plat I <br /> Unplatted Descdption: Sewer Bond Dfsirict � <br /> � <br /> i <br /> Aburiing Lot Lfne i <br /> N, S, E,W n� � <br /> � i <br /> Type of Pertnit ••-��i'� 1:� .�� ��L. —�/ � : �:,.:'' T_ APProved By i <br /> ;��l,/� I <br /> Remarks Issued By � <br /> Customer Signature i <br /> � <br /> IMPORTANT! ! <br /> I <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING ! <br /> Inspection By���'/�A" �, <br /> CALL 259-8810 FOR INSPECTION � �y�y <br /> Date Inspected ; <br /> j <br /> SEE SKETCH ATTACHED : a 9 7 ,� � I <br /> INSPECTION - � <br />