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.__;... . . ... .;..;.. . . , . , .. . . . ; . - _ , . . <br /> CHART NO. — - ----- <br /> > � TO POSTING � � 9� <br /> 07tlx .. ... - . . <br /> Q9 H . <br /> t" � � <br /> `y � Sewer Application and Permit <br /> '�1 H "�9 , . � <br /> U1 H <br /> � � � ? � � �5 DATE 3/z4/v� <br /> d <br /> � N <br /> � �g 57J1 lat Dr Se Utilit Accounl No. <br /> Service Address Y <br /> ~ � 1G410 bel-I:ed Ru 6200 <br /> x y B!Iling Address — <br /> g y'3 City, State,Zip i liew� t�'� ee,nm Permit Fee $ _ 7�•�� <br /> �d y Owner ' � r fr Connection Charge <br /> ��� <br /> � yd � Connection by '�-��� � Trunk $ <br /> � <br /> � Address Laleral $ - <br /> Total Conneclion Charge $ �'�� <br /> ( Phone Utiliry Development Fee <br /> �i �� 224.00 <br /> Legal'Descrip�ion: Water S <br /> Lot ���� — Sewer $ <br /> 224.00 <br /> �� Block Totai Development Fee S <br /> I �� Plat l;unobrool: tlic I3 <br /> Unplatted Description: — Sewer Bond District _ L:.zi: <br /> , ��� Abutting Lot Line <br /> N,S,E W ft. <br /> �� Type of Psrmil �;ev connec[lan Approved By <br /> G� <br /> Remarks Issued By _ _ <br /> 1 1_1 Customer Signature _ <br /> �� <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS � <br /> PRIOR TO DIGGING /- <br /> Inspection By�" '�S"�"^- — <br /> CALL 259-8810 FOR INSPECTION y.�;_ 7 3 <br /> , Date Inspected <br /> SEE SKETCH ATTACHED � , , , � <br /> INSPECTION �- '' ' `' �� <br />