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S <br />�SSS�S SSS <br />R � M <br />Seger Applicatio`'�ancL,�Tq,` mit <br />ff <br />9 7 'r G 81 DATE _-25/ <br />Service Address b l . Utility Account No. <br />HART NO. <br />TO POSTING s-2r—g5 <br />Billing Address L; 13 2 2 && <br />City, State, Zip _ 7 3 2G3 Permit Fee $ 76— �J�) <br />Owner f V G 1 /t. AL Connection Charge <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit 72! Ct l Co') r 1, (- i )C I 1 <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />Apnroved By <br />Issued By <br />Customer Signature <br />Inspection By S <br />Date Inspected <br />INSPECTION <br />$ <br />$ / 7900 <br />$ 4/7/. CD <br />$ low U. Cl <br />?r13; <br />ft. <br />