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�r�� <br />9�H <br />t�ii <br />y <br />y ��—t <br />�H� <br />� Vl H <br />x <br />��c <br />oH <br />��g <br />(�] Y (7 <br />�y� <br />Hy <br />gy <br />c�C� <br />��y� <br />HOcyi� <br />� <br />i <br />I _� <br />� �� <br />CHART N0. <br />POSTING � "'°-93 <br />Sewer Application �nd Permit <br />� 1 Z ; ' 'JATE "-:`-"� <br />ServiceAddrass 2„f� '^' 't�rtr.o �'ica `�r <br />Billing Address <br />City, State, Zip "`'Or���c 'dA 9R'UI <br />Owner ti�rxrce�n <br />COM2clion by �"°ricun Bnc}:hnr <br />Address �204 Deverl� Lane <br />E•:ere[t RA 99207 <br />Phone 35�-34Aft <br />Legal Description: <br />Lot -- <br />Block — <br />Plat <br />Unplatted �escription: <br />Typeo}Pefmit ��-r�'r:i[Son <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />PermitFee $ '�''�'�� <br />Conneclion Charge <br />Trunk $ - <br />Lateral g � <br />Total Connection Charge $ . <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Developmenl Fee $ , <br />Sewer Bond Districl _ <br />Abutting Lat Line <br />N, S, E, V�� <br />Approved By <br />�!Ii <br />Issued By <br />C�stomer Sig�aWre — <br />ft. <br />��Jc.��, �' �d�, � . <br />Inspeclion By _. <br />Datelnspected ��?�_/� . <br />INSPECTION <br />p�,3Ga <br />