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i�•.a. <br /> % . , <br /> >i <br /> � CHART NO. <br /> ,_ <br /> r <br /> �° TO POSTING.. 3-��-9 <br /> � <br /> . r � gsg � � g g � � <br /> . � � � � � � g � � � � <br /> rl � � "� <br /> .+ M M .-t <br /> Sewer Applicatior� d P�,� � � �` m � <br /> �° � .. <br /> o � � � � � � � � � � <br /> . ,., $ � s � � � � �� � u � .. � <br /> � -.. 29�$ 5 DATE 8I19/Y3 <br /> Servfce Address �16 l�t Dr W Utlliry Account No. _ <br /> BlHinp Address 2'+7 c�� se . <br /> CftY,Stete,Zip a-.�.. v. . ; Z ' . <br /> D8303 Permit Fee a �i1.00 <br /> ; _ <br /> ! p�e� 9�l�at bu� Connection Charge <br /> Conrrection by <br /> Tn�nk a <br /> � Address Lateral $ <br /> Total Connectbn Charye S '�' <br /> ' Ph°�e Utfliry Development Fee <br /> i <br /> Lepal Desc�iption: Water 179.00 <br /> � a <br /> Lot 13 <br /> Sewer a <br /> � B� Total Development Fee a 179.OQ <br /> � Plat ; <br /> Unplatted Deecription: Sewer Bond Diatdct ULID /1 <br /> - Abutting Lot Line <br /> � N�S, E.W R. <br /> Type of PermR N„+ cona�ction Approved By <br /> Remarks — Issued By 8b <br /> CustomerSignature y7•--�� '�' <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPEC110N Inspection By <br /> , ___ , Date Inspected �— 3 �7 �`" <br /> SEE SKETCH /�TTACHED <br /> INSPECTION ,° z�3 Q'Fj <br />