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�� <br />,' r . - —.; . ---- 3. ;.---; - <br />�.'. .__T .--r_'__. - .._ ..F., .. . � <br />i <br />�� �` _ <br />Sewer Application„and Permit <br />? 9 h 1 1 DATE °�3/93 <br />9L19 Srnre St ,�..�....e__.,....�ni,. <br />i, SBNIC@ NOOfB55 — <br />I BillingAddress 5an` <br />City, State, Zip !'v� taA nA%�� <br />� Owner r�� <br />I • <br />� . �� �) i� <br />� Connection by � ' <br />I li ��Jl( Q�ii � <br />Address <br />'� L v��r�-ft 9�2c1 _ <br />Phone � 3'� ' �G Z..� <br />I Legal Description: <br />iLot <br />i Block <br />i Plat <br />� Unplatted Descdption: <br />Type ot Pe�mit Al[eratlon/Rep¢ir <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 />CHART NO. <br />TO POSiING « � 3 <br />Permit Fee $ _ <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />30.00 <br />Sewer Bond District <br />Abutting Lot Line <br />N, 5, F, W <br />Approved By — <br />Issued By <br />Customer Signature'� ' '' Y' r`' <br />!� � <br />n. <br />Inspection By ( ,G' � c' �i'"G < <br />Datelnspected %'�3��3 ' <br />INSPECTION <br />?c:4i? <br />