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� � CHART NO. -- - — <br /> c� <br /> i0 G <br /> ❑ H <br /> � � H -- �2 -/7-`/ z <br /> K y � TO P6STING <br /> m N � , � <br /> � � � , <br /> n <br /> � � � ' Sewer Application and Permit <br /> Ly y � � . . . . _ <br /> i [ <br /> o y � �� .�t^ ':� DATE u/�/�2 <br /> n o m <br /> � � � Service Address �OB 41rt 1�1 Utility Account No. <br /> � cv�i <br /> Billing Address — 3240 EastlaYe Ave E 92G0 <br /> City, State, Zip <br /> __..,_ ..�. yR np� PermitFee $ 70.00 <br /> Owner <br /> Connection Charge <br /> Connection by <br /> Spru �r ErN� En �� Trunk $ , <br /> � \ddress — <br /> Lateral $ <br /> i c.o0 <br /> � _ Total Connection Charge $ <br /> � Phone Utiliry Development Fee <br /> '���� I g r�y.�;� <br /> i �� �i Legal Description: Water <br /> $ ��7i._00 _ <br /> I ` Sewer <br /> I Lot <br /> 1 'o� I Total Development Fee $ U'��'�'� <br /> ��� Block <br /> ' Plal _ <br /> iUnplatted Description: Sewer Bond District <br /> � �� Abutting Loi Line <br /> I N, S, E,W n� <br /> � <br /> I ' '' I' Type of Parmit _ - - -^' n — Approved By ----- <br /> Remarks <br /> Insued By Gs <br /> � �=1-� . CusiomerSignature -- <br /> � <br /> I IMPORTANT! <br /> �0 (� CALL 1-500-424-5555 48-HOURS � <br /> PRIOR�O DIGGING <br /> inspectionBy ��`w"�'� ' � <br /> CALL 259-8610 FOR INSPECTION Date Inspected � -�"� �� L <br /> SEE SKETCH ATTACHED o - ,^ �c� <br /> INSPECTION " <br />