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1 <br /> CHARTNO. ------ <br /> I TO PC�T���, �=s -5� <br /> �� 'tl I ' ' <br /> � <br /> yH I I <br /> O`A C'C � . . . ._ i:; �._-. <br /> y H N 'i� �. � .�. �r �:, <br /> � �� ! Sewer Application and Permit ; u, <br /> H� I _ <br /> � yH � �? ,�,) ") �Zil/�'. : - ` - �.� . <br /> DATE <br /> � zO I <br /> � H � 6102 Lat Dr SL' Ulilit Account No. - <br /> o ti I Service Address Y <br /> H�g ;�� � s��,, n.,� s,> <br /> �. o I Billing Address <br /> xH <br /> � v,, t.,�.n__^GG.7.2 Permit Fee $ 70.UO <br /> � H Ciry, State,Zip az—�� ?r^ — <br /> C7 t~i� y Owner •�a�encurc Const Inc Connection Charge <br /> o M <br /> �b y Trunk $ <br /> �� � Connection by <br /> Ho � � Address Lateral $ <br /> � I Total Connection Charge $ -� <br /> Phone Utility Development Fee <br /> � ll9.00 <br /> � ' Legal Description: Water $ <br /> I 1_� ��� 1S Sewer $ 47!.00 <br /> ` Lot <br /> Block Total Development Fee $ fi''�•��� <br /> 1_� ; Plal 1_idgew�oud Ter f71v II <br /> � ��� <br /> � Unpiatted Description: Sewer Bond District <br /> � � Abutting Lot Line <br /> ! �I� I N,S,E,W n' <br /> II Type of Pormit �,,-�F��— Approved By <br /> �,b <br /> �� II Remarks IssuedBy <br /> i Customer Signature <br /> �� II <br /> �I�. IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> II PRIOR TO DIGGING <br /> I CALL 259•8810 FOR INSPECTION Inspection By <br /> �� <br /> � Date Inspected �- '��' t� <br /> � <br /> ISEE SKETCH AT7ACHED ��„ A „ <br /> I INSPECTION �- � - -� <br />