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� - ------- --- <br /> _ ._ _ <br /> CHART NO. — <br /> �{ <br /> � �� <br /> [s� H � �` � <br /> t�y y <br /> 0 P05TING s''�'- 5 <br /> ��� � ' ' r�d Permit <br /> �y� �, Sewer Application a <br /> �i�� „ J-, - � DATE 7/�a/y3 <br /> v <br /> s"�g �� Service Address 11'�� le:t ll: S�: Utility Account No. <br /> Z N� � <br /> � H y i Billing Address :�!��r.e <br /> � fverecc it� °����7; PermitFee 8 ���'��� <br /> g�'H j City,State,Zip <br /> ��� i Williac ll. i.oy Connection Charge <br /> Owner <br /> y� I <br /> y p y � Connection by Trunk $ <br /> i <br /> � II Address Lateral $ <br /> Tolal Connection Charge $ <br /> � � Phone Uliliry Development Fee <br /> I L� ' Legal Description: Water � <br /> I Lot ZS Sewer $ <br /> � `w� Block Total Development Fee $ <br /> � <br /> � Plat <br /> � II Unplatted Uescription: Sewer 6und Disinct <br /> � ��� Abutting Lot Line <br /> I N,S,E�W tt. <br /> !� <br /> 1�' I Type ol Permit :�ew cor,rcc r Lmi Approved By <br /> Issued By �L <br /> Remarks _ <br /> ���� ' �' , , - <br /> � Customer Signature�\� � <br /> � IMPORTA�TI <br /> CALL 1-500-424-5555 48-HOURS <br /> � PRIOR TO DIGGING � � ; <br /> Inspection B/ / <br /> ' CALL 259-8810 FOR INSPECTION c� <br /> Datelnspected . <br /> SEE SKETCH ATTACHED , , - <br /> INSPECTION - � �' '� <br />