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��y� <br />A�lx <br />�HxN <br />HxM <br />k � <br />H� <br />�fAM <br />x <br />o�d <br />��g <br />My �❑3 <br />� H C+7 <br />HH <br />g�' <br />H <br />c]C� <br />��� <br />HO� <br />� <br />�ie� CHARTNO. ------ <br />P� �3 � � ura�er <br />! Sewer Application and Permit <br />: �^,p7 <br />DATE '%- t � - <br />TO POSTING_ 5-a�-53 <br />I Service Address =�-i` Sc:'c" "` Utility Account No. <br />il <br />I Billing Address rnTn <br />� Ciry, State, Zip t:'�°T"�t wn 9t����l Permit Fee S -��','�� <br />; <br />Owner %rillL,�, u�:b��r ConnectionCharge <br />i Connection by n'+'neT�i< < n �� �� Trunk S. <br />�, Address Lateral $ <br />Tolal Connection Charge $ ----� <br />Phone �5:–Q537 UtilityDevelopmentFee <br />Legal Description: Water 5 `�'•��+`%�ti� — <br />Lot Sewer 5 ''��'� <br />Biock Total Development Fee $ '�'�`'�` <br />�� Plat <br />� Unplatted Description: Sewer Bond District <br />I�� <br />� � <br />� Type ot Permit <br />Remarks _ <br />; – <br />� <br />NS��raCimi <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTiON <br />SEE SKETCli A7TACHED <br />Abut�ing Lot Line <br />N, 5, E, W <br />Approved By <br />Issued By �� <br />Customer Signature '� �' � <br />Inspection By _ <br />Dale Inspec�ed <br />INSPECTION <br />/" <br />Cj�yP�L1n.� <br />>_iu -`i3 <br />7; ' <br />ft. <br />