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Sewer Application and Permit <br />?.9139 DATE �`�Z��� <br />4-• Sbeh Pl SE Utilit Account No. <br />Service Address y <br />Billing Address <br />City, State, Zip <br />14410 Bel-Aed Rd J2C0 <br />Bellewe lJA 9li007 <br />Owner (:olony Craft <br />Connection by �� <br />Address <br />Phone — <br />Legal Description: <br />70 <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Hnnnnbrcok Div t0 <br />Type of Permit � New connaction <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART N0. <br />t0 POSTING � � " � <br />�.�F�`Uti/r_t o�, ffu$tJ �.F<{_i. . <br />PermitFee $ / ,•���o�_ <br />aoCn,�,�� <br />Connection Charge 6�LD�� �5%4•DO <br />FLF� S91.C�D <br />Trunk �;}i , . <br />Lst�ral ;:i-� SJ.O.CO <br />� Sn.G . . J <br />Total Connection Charge����'� �`�'� <br />ii�!('.�ut�.: (e <br />Utiliry Development Fee �n' � •�c qE�-� <br />:"�'�C� �°� 179.00 <br />Water �;�pT�' a+ns m __ <br />liQf C�291'•7 <br />Sewer ;,� „ . , - • <br />Total Development Fee ' 17A�'S A`C4�� 179.00 <br />ki000. . v <br />L'LDG �567.5U <br />�'IE:G �9 - N1 <br />Sewer Bond District t+FCk �s9[� u�� <br />C;IDG �10.t1L' <br />Abutting Lot Line B SFCH :4.SQ <br />C�RVW'7 3^U.6C ft. <br />N, S, E, W _ . <br />lJl1TfR �;1E�5.� <br />Approved By ,� , „, <br />f,�FT.�O 'E6�lGB� <br />IssuedBy ���j��,,.�,;� <br />Customer Signature "�`wE� ' '� � __i <br />i]71!; t�79.1]0 `- <br />�. ��liG!;i; 5�.;?''S. �O <br />Inspection By / ���'H , <br />Date Inspected J'�> l3 A <br />INSPECTION <br />. 2 .'�a 13 .�,` <br />