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CHART NO. <br />' �" 10 <br />.. r C� i.' i_. _ <br />'.1 : 1.-� � L � <br />c • o P b U P <br />� ' 'O FJ <br />Ly� .. �, n �-1 W <br />C: C; <br />. � '•"1 �•� M 4` <br />� Sewer Application and Per,rriit �= �, l�_, <br />I � � I� i M �.. �. <br />�.; ���`# �:4�r ruw� <br />�� j ..� i_'. �-t i.i _ , r.J T <br />� :[ '.:/i�� . .r . " <br />� 37 � 4 DATE %-�l - %�� <br />Service Address 2� L G� �{ �� �/1 1/ 1 i i �'ll �' (; L•Utility Account No. <br />I 1• <br />Billing Address � Z�' � � �� �! 1 r'r :), /��✓ <br />• " / <br />^ � � � _,____�_ Permit Fea $ _ ��� �7� <br />City, State, Zip , ri ft �i, ✓�� '�l i' 2)- <br />Owner � �� ���( fn1i� rl1 f.!� � y/� »> ��'�� �' ��; Connection Charge <br />i �7 - <br />Connection by Trunk <br />Address Lateral <br />POSTING � � �r -�' - <br />Phone <br />Legal Descriptfon: <br />� Lot <br />I Block <br />I <br />i Plat <br />� Unplatted Description: <br />Type of Permit `�)i�L�,� i`! t 1�)� i�iri, : <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />$ <br />E <br />Total Connection Charge $ ~`" <br />Utility Development Fee <br />Water $ �`�`�' �j <br />$ �r• : �� <br />Sewer <br />Total Development Fee $ � `Zh �Y�-- <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By �'� — <br />�usromer Signature , <br />/ % /� <br />, �*: <br />Y.C� <br />Inspection By �' " <br />,� !^� <br />Date Inspected <br />SEE SKETCH ATTACHED . ? q � c� ,+ <br />_ . _.__ - INSPECTION ` <br />ft. <br />