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. . . . . .. , , .'�'•�.;a7�'�'...�+'.:�h,�r.tot�ce�;��-�'•�.t^F�M1:- .:aD�."�,�.'��'';+�.ew�p-^xY'rm:r.^��:�a* <br /> CN:�RT NO. __ — <br /> n <br /> i: <br /> �; T . POSTING_. S� - <br /> :w�, � . � � � � � � o <br /> � !t � r. �3 `[3 <br /> `� �_ r� r � r1 C� V O ��1 <br /> vi 7- cY . � ;o : r.: �� <br /> � » ... . +^ W � <br /> c ` :+ " ., <br /> Sewer Applic�#i�n an� ,l���rLit. <br /> ; =. ,, 1 �� � �' w �� <br /> d o �S ..ir, � i� �Q- � � � !G, <br /> `Y' � tJ 2l � JJ C �L�x "—'y,Y�1f'a C_l . <br /> . . ' 23G $$ DATE " � ��`�'� <br /> . <br /> Service Address 7�L�Gr f '�1 �� . Utiliry Account No. • . � <br /> BIIIinpAddress �.(i'7// �'ll('•1��[D.C:i') // )� _ <br /> Cfly,State,Zip �� ��'� 2G'� Permit Fee $ _ ?�' �r� <br /> Owner L � � ���'����f�� � Connection Charge <br /> Connection by Trunk $ <br /> Address ��t Lateral s <br /> Total Connection Cherge S '�" <br /> Ptane Utility Development Fee <br /> ' Lepal Description: Water S /7/a. ��1 <br /> �� / seWa� a ��7/. G7J <br /> � B� Total Development Fee S �'��� <br /> P�t ,..���> 22-� <br /> Unpletted DescxlPl�on. Sewer Bonu District <br /> Abutting Lot Line <br /> N,S, E,W ft. � <br /> TYpe of Permit ��411 I ('�1 Ll)P l" /P) i Approved By <br /> Remarks <br /> Issued By �� <br /> Cusromer Sigoature <br /> IMPORTANTI <br /> CALL 1-500-424•5555 48-HOURS <br /> PRIOR TO DIGGING <br /> Inspection By Or�p <br /> CALL 259-8810 FOR INSPECTION Date Inspected � '�'`�y — <br /> SEE SKETCH ATfACHED , Z g Q a;� <br /> INSPECTION <br />