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dpraav'7+"r�.�+•tiu��%�..s-t.trP.N+t:�M:-..is r.a.uo,,..,�.�7r:,Y7'-F�'� ..:c .s::W,H�P'"1�'Hr . .7, . . ;. . <br /> ... " CHART NO. <br /> � � y� '� �99� <br /> �� �� �' �- TO POSTING MAR 0 5 <br /> _ ,.; , <br /> Sewer Application and�;Permit <br /> � `� 2 97 4'J DATE .:. .; :=`�: �j.�[I <br /> Service Address �2�'� ������ L�� Utility Account No. <br /> Billing Address �� 3�` <br /> Ciry, State, Zip ��•Y2G'� Permit Fee $ �l/, L�i <br /> Owner ����%�C���:.� ,���*�r -- ConnectionCharge I <br /> Connection by Trunk $_ <br /> Address Lateral $ <br /> Total ConnecUon Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> Lot _ Sewer $ <br /> Biock Total Development Fee 3 <br /> Plat <br /> � Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> . N� S� E,W ft. <br /> Type of Permit � �,r7 r':� �1/I i ; Approved By <br /> Remarks J Issued By � <br /> Customer Signature <br /> IMPdRTANT! �-1 P ���� ,�, <br /> /�0 1 N S <br /> CALL 1-800-424-5555 48-HOURS — �--Zr'-'C� ' "/9� <br /> PRIOR TO DIGGING --- -- - - — <br /> CALL 259-8810 FOR INSPECTION Inspection ey <br /> Date Inspected <br /> ; SEE SK�ETCH ATTACHED <br /> INSPECTION �� �4 7�t � <br /> I <br /> I <br /> � <br />