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• �. . . . .�N ..�.� .. .. , , , . . . . ...r,F�,.,�--—�r--'--.T'?� .. <br /> �� ; CHARTNO. —..----- <br /> .� <br /> � 5 � �.� - � - _ F _ �_;�z ro aosriNc �L"7D'9} <br /> ,ti =;�_ w' > �,�;" _ , - _ - <br /> � , , ., - <br /> ,. ` � <br /> Sewer Apptication and _I?er.tnif� <br /> . " �` � �., ;� ` , `;�- y � '' `_ <br /> 2 9 1 D� `- DATE g/3o�93 ' ' . <br /> ServiceAddress Sa26 lec ur u UlilityAxountNo. <br /> Billing Adtlress 237 Elm St _ - <br /> City,Stare,Zip sverecc t.'A 982n7 Permit Fee $ 7n.UD • <br /> Owner co+��� ���..� ConnedionCharge <br /> Connedionby JC� Trunk $ <br /> Address Lateral S <br /> Total Connection Charge S _� <br /> r'hone Utility Deveiopment Fee <br /> Legal Description: Water $ 179.00 <br /> Lot /1 Sewer $ <br /> Block Total Develooment Fee § 179.00 <br /> Plal NannLzook ll!v 4 <br /> Unplatted Description: Sewer Bond Disirict �'I� �� <br /> Abutling Lo�Line <br /> N,S,E,W h• <br /> TypeolPernll Nav connoc[Son qpprovedBy <br /> Remerks Issued By eb <br /> � CustomerSignamre"-'_� �//f� �" / ���'" <br /> " IMPORTANTI <br /> CALL 1-H00-424-5555 48•HOURS <br /> PRIOR TO DIGGING / <br /> Inspedion By ���"'///%�'�' <br /> CALL 259-8810 FOR INSPECTION <br /> , oatelnspected //-�'-51 <br /> SEE SKETCH ATTACHED <br /> \ INSPECTION - ��a�� <br />