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h <br /> � <br /> D�x ` . �� - - � <br /> . _ . . .. . , _ . . .,� . .r. <br /> ayy � _ ' " ' I . <br /> ,� „ <br /> 'r .4.-.' :. fr -.•n�:. � _ ._ S..a..R'.. :Y. � �:':+. ' 'C", �. ..., T ' ,. •'�� �i <br /> . : .. . .�..:-' . <br /> �� �e - CHART N0. I <br /> �a��a <br /> C�7 yoy <br /> Ot�� - <br /> ��g = �� TO PQ�T�n�r, 3-3�- <br /> �, <br /> �� A .... � - . - <br /> �M� Sewer Application and :Permit <br /> g y - ", � ` — `_' <br /> �N�' :� . <br /> ,_ s. <br /> e m �;)OI f DATE 7.-]9-93 <br /> y p y 10505 19ch Avc SF. <br /> Service Address _ — Ulility Account No. <br /> Billing Address f°'a`� _ <br /> City, State,Zip rvereec t,A 9320i, Permit Fee $ 70•�� I <br /> Owner Fict�ard S Shnrel Pur.;.tev ConnectionCharge <br /> Connection by Truvk $ 3��'�� ' <br /> I ` . Address Lateral g �`S.Ob I <br /> Total Connection Charge $ �'S.00 <br /> Phone 338'J5Z'+ Uti!ity Development Fee <br />� '�' Legal Description: Water $ 179.00 <br />' ��' Lot Sewer $ �`7�'�Q <br /> '�1 Block Total Development Fee $ 650.00 <br />: � <br />� ��' Plat ' <br /> 1 Unpiatted Description: Sewer Bond Dist�ct Aor.d 117 _ i <br /> ' Abutting Lat Line <br /> '�1 N�S� E,�N tt• <br /> 1f TypeofPermit �ew cnnnr.ceto,: ApprovedBy <br /> � >itt i <br /> �' Remarks — Issued �y— -- <br /> � CustomerSignature_..:!'�� � -�' % ' '' "�"� <br /> � ,i / I <br /> IMPORTANT! j <br /> � I <br /> � CALL t-800-424-5555 48-HOURS ' <br /> PRIOR 70 DIGGING n � <br /> — p � � I <br /> CALL 259-8810 FOR INSPECTION Inspection By _ I <br /> Datelnspected 3 l �� <br /> I <br /> I <br /> SEE SKETCH ATTACHED ,� ;. : � „ � <br /> INSPECTION <br /> i <br />