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� <br /> � <br /> �� '� <br /> H <br /> ' ------- - � - -- -- ----- -- -- -- ------- -- --. _ _.._._. . . ._..._._ <br /> --. .._ -- ----.. _ _----_.__ .I ,: <br /> G F; 'r- .. _ _.. . _ .. - . , . . � .. . . . .. .. , . . <br /> 9 H .� <br /> y �� CHART NO. - <br /> fe o <br /> �+tlH �tl <br /> oy� � TO POSTIh.�!' � -���_ <br /> � d -, � � �; �' �.: _ �- <br /> � ,.; •� , �; � 1 � � <br /> � � g _ t .. . � � _. _ _ ��; <br /> � y� I' Sewer Applicatia�, and Perrx�it ,� � <br /> H H � - } , �-� ;' 't -�; � � � <br /> gd�' , 2 ' ; � 1 J DATE ,:: a/31�2 � , 1 `� <br /> ���� 2216 Col�biu <br /> �n Service Address — Utility Account No. — � <br /> Billing Address PO Box 3376 <br /> Ciry,State,Zip � r ' � qA?�9 Permit Fee $ 70.00 <br /> i <br /> I Owner t�sc' Connection Ch;rge <br /> Connection by — Trunk $ 270.00 <br /> i Address Late�al g 450.00 <br /> i <br /> Total Connection Charge $ 120.00 <br /> Phone Utility Development Fee <br /> '�� Legal Description: Water g 179.Oo <br /> '�' Lot Sewer $ �7�— <br /> Block Total Development Fee $ 650.OG <br /> � ' <br /> 1_' Plat <br /> '�� Unplatted Description: Sewer Bond District !i — <br /> � ' Abutting Lot Line <br /> � <br /> N, S, E,W n. <br /> '�' Type ot Permit New Coanection Approved By � <br /> ' Remarks Issued By B� <br /> I <br /> ' Customer Signature � '� ' �-� � - �,"�. <br /> � � <br /> IMPORTANT! <br /> ��e � , <br /> 1 ' j CALL 1-500-424-5555 48-HOURS <br /> � PRIOR TO DIGGING i' ; <br /> /� � : <br /> CALL 259-8810 FOR INSPECTION Inspection BK_Ler��� — <br /> Date Inspected v � <br /> � <br /> �, <br /> SEE SKETCH A7TACHED <br /> IN.PECTION `: 2 3�J t <br /> � <br /> _ _- --- -_ - - - 1 <br /> _ - - _ _ -- <br /> � <br /> ; <br />