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CH,4RT N0. -- <br /> � <br /> � �� '� <br /> H <br /> � y N i j0 POSTING � -_--a'"93 <br /> y�" '� Sewer Application and Permit <br /> � H� <br /> oxo <br /> "il H �i1 <br /> �x� ? q? ^ � DATE — '-�3-:� a <br /> � e <br /> � �g Service Address <br /> �ul st l::e '�� Sti UtilityAccountNo. <br /> �` n Pvrrett S:A 98:.On . <br /> Billing Address <br /> �H� � Permit Fee $ '��.�?`'' <br /> H y j Ciry,State,Zip <br /> �N Conneclion Charge <br /> dy ., OW�Bf llciin]d Lncl�:�o:�ll�• . <br /> ��� �� Trunk $ <br /> Connection by <br /> y� � Address — Lateral § <br /> Total Connec:ion Charc�e $ <br /> � phone Utility Development Fee <br /> ' Water § <br /> � �� Legal Description: <br /> Sewer $ <br /> Lot <br /> Tutal Developmm�t Fee $ <br /> r� <br /> , Block <br /> i �� i Plat <br /> Unplatted Description: <br /> Sewer Bond Dislrict <br /> � Abutting Lot Line <br /> /� �� N,S,E,W n <br /> !•R <br /> ��1-� TYPe af Permit ,"�' ��r.r.�u�on P�proved By ;'', <br /> Issued By ; �/ <br /> � ' Remarks <br /> ,' ;.r i - � �' � t �,-.� �7 <br /> CustomerSignaWre ` � <br /> Ll l `� <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS � J <br /> PRIOR TO DIGGING <br /> Inspection By <br /> CALL 259-8810 FOR INSPECTION Date Inspected <br /> SEE SKETCH ATTACHEU -� �: ^,? � <br /> INSPECTION " <br />