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�__"____'-__ �-_ ____'___-"--.._.__ ._. ._ _ `t_."-_____._".__'_ .. <br /> CHART NO. --- <br /> i <br /> � <br /> � �� I - t0 POSTING���_ <br /> D 70 x �� - � � � -. . <br /> C H i <br /> y�� '; Sewer Application and Permit -� ;^, ` <br /> oxa � _ - <br /> �� � , <br /> v,H ^ ` DATE ';� <br /> � J j .' ^, <br /> p ���y I Service Address ' ����C — ��� � �J�� �'� J . , Utiliry Account No. <br /> r�i [��7 p � 237 ELM ST <br /> �. � Billing Address <br /> x t� � I EVF.SETY ItA 9H�_'03 ;0.00 �. <br /> > y z City, State,Zip Permit Fee $ _ <br /> tY I <br /> p.i H . SGLF:CT 90`!i.: <br /> g m i Jwner — Connection Charge <br /> �d y � Connection by �C � Trunk $ <br /> �� r <br /> �� y Address Laceral $ <br /> � <br /> � Total Connection Charge $ �i.On <br /> Phone Utility Development Fee <br /> t�n,,. � <br /> � I Legal Description: Water $ <br /> I �� • <br /> Lot ' Z sewer S ��.�,i� <br /> �, Block Total Development Fee $ <br /> iI_�1 'i Plel H:1�AIiXOOX �!IV 7 <br /> `� Ui,1i� <br /> Unpiatted Description: Sewer Bond Uistrict — <br /> ' Abutting Lot Line <br /> �I I i N,S. E�W fl. <br /> '� IiF.11 C0:1':F:CTLO'.� <br /> , Type ot Permit Approved By / <br /> �'�� Remarks Issued By_ '��`' ' <br /> �� � : ,�." �,1Gi. � � �u_.�.,�_ <br /> ✓ <br /> Customer Signature�� !��; '���� ��— <br /> ��I I IMPORTANT! <br /> ' CALL 1-800-424-5555 48-HOURS <br /> Pfi!OR TO DIGGING <br /> � CALL 259-8810 FOR INSPECTION Inspec�ion ey �����'��N u'� <br /> Dato Inspected ��� � '�3 <br /> i <br /> ' SEE SKETCH ATTACHED <br /> � INSPECTION � ?� � �� � <br />