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-.L,. <br /> .�._ <br /> �. <br /> t <br /> �--- ---------- - ----- -- ----- - <br /> ; <br />� ' � CHART NO. ��� <br /> I <br /> I <br /> � m pncriNf, �-.s-93 ��� <br /> Ii <br /> I� :� I <br /> � � I G ; = `� �; � ; <br /> ��� �� . . ' ;- _ ,:.. - �o I <br /> � y � Sewer Application,and Permifi , � � � , , <br /> �. � : �� , � � � <br /> H H `_ ` - � � ' � ' : `_; � <br /> � _ � _ � <br /> o x o I 2 '� '�� DATE 9-1-9z � <br /> 'il N�il � � I <br /> �7 y~ 2942 M�ple St. � '� <br /> � aC� Service Address Utilit�Account No. <br /> i <br /> O � dey Billing Address 521 wnll Strer.t I I <br /> Q� � � City,State,Zip 5eaccic wp 98!?1 PermitFee $ 10.00 i <br /> Gcoup Health � <br /> �,z, ��-7 ; Owner Connection Charge <br /> �..i y I <br /> gy Connection by Trunk $ � <br /> N � <br /> ClC�fp i <br /> � � Address Lateral $ <br /> '�� Total Connection Charge $ <br /> Phone 448-2355 Utility Development Fee <br /> � Legal Description: Water $ <br /> Lot 58 6 Suu[h hnl6foi Lot 59 Sewer $ <br /> IC' Block 695 Totai Development Fee $ <br /> i � <br /> Plat oj �v�rntt <br /> � i <br /> � Unplatted Description: Sewer Bond District I ; <br /> ' �� i <br /> I Abutting Lot Line ,I <br /> il ,_� ', N,S, E,W R. II <br /> ` ; <br /> � Type of Permit Cap o�f Approved By <br /> � �� Issued By ��1 / i <br /> Remarks _. <br /> �I� CustomerSignatura.r:�%j �„ '•�'S Li�t��� � r:L. <br /> � / <br /> IMPORTANT! <br /> �� CALL 1-500-424-5555 48-HOURS <br /> ; PRIOR TO DIGGING ,,� <br /> I� CALL 259-8810 FOR INSPECTION Inspection By /�� �',/"'�°� <br /> Date Inspected '�'eG ����3 I <br /> I SEE SKETCH ATTACHED <br /> INSPECTION � � � � % � <br /> I <br />