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�: <br />� <br />�� �s�� ;�p �p sy� as�p, <br />VI C: 9pV' ���� (1 tl O fG" (1 O� <br />•O V 1•, w d� fa .� N(�1 y <br />ru A A M M Y <br />Sewer Ap��ic�ti n a ���.' �t� <br />� � av��.�� � s;�a <br />� Y����:���� �x��� <br />-. 29235 � DATE �-/.F-q,� — <br />Service Address � � " `'� �n �� I � � . i £ . Utility Account No. <br />Billing Addreu 14410 BEL-REn M <br />Cily, Stete, Zip BELLEVIIP. NA 9800) Permit Fae $ <br />p�y�� rmnur rn�vr Connecli.�nCharge <br />Connection by �C1� Trunk <br />Address <br />Phone _. <br />Lepal Descriplion: <br />Lot _ <br />Bbck <br />p�g� {IANABROOR DIV II <br />Unpletted Descriptlon: <br />Type of Permft NEW fAHNF.CTION <br />Remerks <br />IMPORTANTI <br />CALL �-800-4245555 48-HCi:!^nS <br />PRIOR TO DiGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />� <br />T6 POSi1NG._ 1�-5-53 <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />70.00 <br />$ <br />$ <br />$ -o- <br />$ <br />$ <br />S <br />224.00 <br />224.00 <br />Sewer Bond Dis�rid ��t *^ <br />Abutting Lot Line <br />N, S, E, W — �• <br />Approved BY - <br />Issued By <br />Customer Sipnewre n'� <br />✓ <br />. . . ,_ ;Y .. , <br />Inapecllon By �� ��� <br />Dete Inspected G aT-i � <br />INSPECTIO'.V <br />, '_ 24235 <br />