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p � � C �T N0. ---- I <br /> $ <br /> [�' M <br /> q yC �n <br /> y Y r=i <br /> K n <br /> .� x <br /> o m o <br /> �o .. w <br /> N M <br /> H <br /> it 2 .[ f; <br /> `° � � T� nncTtNf, � �a z <br /> � y � Sewer Application and P�ermit <br /> F+ H <br /> p N <br /> R � y " DATE �l�z/�; <br /> x �er <br /> � ro <br /> ° y Service Address �"��' ��ic:or ['] Ulility Account No. <br /> Sanc <br /> Billing Address <br /> Ciry,State,Zip � �'bratc iJn 9ti201 permit Fee $ - �� ,���.� — <br /> Owner :4ildred tlileon Connection Charge <br /> Connection oy Trunk $— <br /> Address Lateral $ <br /> Tolal Connection Charge $ <br /> ��� Phone _ Utiliry Development Fee <br /> � Water $ <br /> Legal Description: <br /> i $ <br /> 1 �� Lot Sewer <br /> i W7U�;.i'.d' ' <br /> !'�'' Block _ Total Development Fee $ <br /> Pla! , ..:�� <br /> ���Il[; !.;,.�lii <br /> i �.� Unplatted De�cription: Sewer Bond District i ,�.�; �,, ,� <br /> Abutting Lot Line � "' '�'� <br /> �.�-'�,h;'. .� ., <br /> .► N.S, E,W ,,: .. fl. <br /> ��� <br /> Type ol Permit «apair Approved By <br /> ' � `�' Remarks Issued By _ <br /> , , �' i <br /> Customer Signature �' � <br /> I � t,�' IMPORTANT! <br /> I� CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING � <br /> Inspection By — <br /> CALL 259-8810 FOR INSPECTION �. j _� L <br /> Datelnspected – <br /> SEE SKETCH ATTACHED , � ,� <br /> � INSPECTION ' � � <br />