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� � <br />H <br />�� <br />K�� <br />H �1 <br />M1 N H <br />Zp <br />�HC <br />��g <br />C�] V Ci <br />t�y� <br />hi H <br />gN <br />OCy <br />� � y <br />HON <br />� <br />1 �� <br />S�wer Application aRd Permit <br />N° 29095 DATE � � �_�-- � <br />Service Address ��1�/���GA1/,;'��,�'j���Q. Utility Account No. — <br />Billing Address -- ���Ey ��y�'� � <br />Ciry, State, Zip Permit Fee S <br />Owner Connection Charge <br />Connection by _ Trunk <br />Address <br />Phone <br />Legal Description: <br />Lot _ <br />Block <br />Plat <br />Unpiatled Descrip;ion: <br />Type of Permit <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />No. =�_ -��_ ��,� <br />S <br />5 <br />$ <br />S <br />$ <br />5 <br />Sewer Bond Disirict <br />Abufling Lot Line <br />N� S, E, W ft. <br />Appraved By <br />Issued By �({(� ��/i <br />Customer Signature <br />CALL 259-8810 FOR INSPECTIOI� Inspection By _ <br />Date Inspected <br />SEF:SKETCH ATTACHED <br />CUSTOMER COPY <br />N° 29095 <br />