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P'1R�^T.` �"vS"�"yr�A.`�'�-c�..a�F'Sr�;n;.�1N'a,t�a►T�'lh�l�e.ssi.Tnir4+l+.4•,..�:��r�tYn:.:T+R�?���:'�sa: .lRn,A+.•?l;;c{tj':n;�ryr��.,-S:•�nr.��"�!f <br /> + <br /> � CHART N0. — <br /> ;s <br /> �_ <br /> � - k, � ._ TO Pc�cr�N� �i—� <br /> _ �;.; <br /> � <br /> , �, <br /> ,LL <br /> �; _. _ .. <br /> Sewer Appli�atio��a;n��;Permit <br /> �i _ _ �, � �. <br /> � =� 4 � �: <br /> 29724 - �� J � <br /> DATE ` ` � — <br /> Service Address �l���� � ���t��'f�L Utility Axount No. <br /> c^ <br /> Billing Address �.a�� � >> P <br /> City, State, Zip Permit Fee $ �'�' �G' <br /> Owner �� `� �'��1 ��+` L'�l�S �--?��<—' Connection Charge <br /> Connection by Trunk $ <br /> Address Lateral g <br /> Total Connection Charge $ fr <br /> ; , Phone Utility Development Fee <br /> ' �Legal Description: Water $ <br /> Lot Sewer $ <br /> Block Total Development Fee $ '�" <br /> Plat <br /> l�nplatted Descriptfon: Sewer Bond District <br /> Abutting Lot Line <br /> N�g� E�yy ft. <br /> Type of Permit /)Q[> > C�,)7.)�r-'i�r�.� � . _ APProved By <br /> Remarks Issued By �� <br /> �( ,?l,1�. r���l. �-�� - {L�� Customer Signature ' <br /> 1 / l <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING - <br /> CkLL 259-881dFOA IN3PECTIQN , Inspection B <br /> , � <br /> � - - � Date Inspected <br /> SEE SKETCH ATTACHED , 2��� � <br /> INSPECTION - <br /> � <br />