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, - . . •�•---,� <br /> � <br /> CHART NO. <br /> � <br /> �� TO POSTING �-Z9-Q� <br /> � <br /> _ � � s � � � �: � � �: <br /> �. . • o <br /> � � � ct� `� �+ � M � � v ? <br /> ' A � � F <br /> Sewer Applicatior� �nd Pe�r�t � � � � <br /> n �FL{ � `3� � 4: � LL � 3 � u�ir � i <br /> ' ':� 2 9 S 8 9 DATE .?-/S/-�� <br /> Service Address ���L� 2�J�: /S ' l •� Utility Account No. • <br /> BfllinpAddreso —, � C -�l�Zc'_Lyl� �� <br /> City,State,Zip ���� / a �'`� Permit Fee $ ���r% <br /> /� � <br /> Owner 'L � L- <--'��C�-�1� Connection Charge � <br /> Connection by � N S �2� a�_ T�unk S <br /> Address Laterel E <br /> Total Connection Charge $ v <br /> Phone _ Utiliry Development Fee � <br /> Leyal Descriptlon: Water $ � 7��• G� <br /> Lot � `�7 >l�-7Z Sewer S �7�.C� <br /> Blodc Total Development Fee y l����• �� <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> , N,S,E,W � <br /> Type of Permit Approved By — <br /> Remarks — Issued By <br /> _ Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING //�� ) / <br /> Inspection By � '��6 Pl��'r <br /> CALL 259-8810 FOR INSPECTION <br /> _ Date inspected s��y <br /> I <br /> SEE SKETCH ATTACHED � <br /> INSPECTION • •� Z g� B � <br />