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---- -------�— <br /> _ <br /> I CHART NO. <br /> , TO POSTING — a_9 <br /> i <br /> � � �' f -: <br /> vZx , <br /> a � � <br /> y �� � Sewer Ap�lication and Permct <br /> H x1 I <br /> �H � I , z� , t DATE - - '�� <br /> �H , -. � <br /> � xo� i <br /> o N t1 Service Address ���" 'l"`}`"'��"r ,1v'� Utility Account No. <br /> H � g ' ro d�,: �ss�, <br /> �� � � BillingAddress <br /> a y{� I City, State, Zip Sr.ohominh taA ?N:"i1 Permit Fee $ 70.n0 <br /> ty i� <br /> gy '� I pwner Cw nrighc Cor.cc Connection Charge <br /> N <br /> ���' Connectionby !^-�°T Trunk $ <br /> � � Address Laleral $ <br /> ow ! <br /> � 1 Total Connection Charge $ � <br /> Phone �+fl'-1i1� UtiliryDevelopmentFee <br /> i � LegalDescription: Water $ 17�'��� <br /> � ��� �, Lot Sewer $ 471.00 <br /> � <br /> i Block _ Total Development Fee $_— �5�•n� <br /> � ._� � Plat <br /> � �� �I 1'.nn2 T (r�•ti.rrdl <br /> , Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> � I' <br /> �I � N,S, E,W ft. <br /> II Type of Permit ^°" ' ^"`"'`� �"" Approved By <br /> ��� <br /> �� Remarks Issued By <br /> I Customer Signature � <br /> `I� , IMPORTANT! <br /> CALL 1-800-424-5555 48•HOURS <br /> ; PRIOR TO DIGGING � /J <br /> ' Inspection By �^"�`""v — <br /> CALL 259-8010 FOR INSPECTION <br /> Date Inspected j�s9��' <br /> i <br /> I SEE SKETCH A7TACHEC ' <br /> INSPECTION � `- '� - • <br />