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��� <br />ay <br />,Dzx <br />axc~n <br />y Y r3i <br />�C C] <br />H� <br />y y L'~'' <br />� O [�+7 <br />Hl7 <br />�/��g <br />y� V C] <br />a H� <br />rHH <br />8y <br />H <br />c� t7 � <br />��� <br />Z H fn <br />H O �n <br />4 <br />CHART N0. <br />TO Pr�,���r_ � F-93 <br />---� <br />Sewer Application and Permit <br />o., ,r, <br />DATE t ,'"t{'�:. <br />Service Address z06 W Marilqu txc <br />Billing AddresS � 16 W�tnrilvn A��c <br />Ciry, State, Zip ��� ** wa ax�nr. <br />Owne� Roaemar� Brunson <br />Connection by <br />Address <br />Phone <br />... .� <br />� I Legai Description: <br />Lot � <br />�e � <br />a � BIoCk <br />Plat 5' <br />�.�..� Unpiatted Description: <br />� d � <br />t��5„�� <br />Type ol Permit Nea connection <br />Remarks l;atr_r service eold 10/9i(i9 <br />on 5.0. L4G0 (9/4") <br />IMPORTANT! <br />CALL t-800-424-5555 48-F'7URS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />Ulility Accounl No. <br />PermitFee $ 70.00 <br />Connection Charge <br />Trunk $ 330.00 <br />Lateral $ 395.00 <br />Total Connection Charge $ 725.00 <br />Utility Development Fee <br />Water $ 2G1.00 <br />Sewer $ fi88'�� <br />Total Development Fee $ 949.00 <br />Sewer Bond District III <br />Abutting Lot Line <br />NgEW ft. <br />Approved 8y <br /><,r <br />Issued By <br />Customer Signature <br />Inspection B�� �/ �� �`-''� ' <br />Datelnspected � > �/!'- <br />SEE SKETCH ATfACHED <br />INSPECTION ' � � f � <br />�N <br />