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<br /> e undersigned Owner hereby mokes application for e sewer con�ection to aew�r �i�li Of `t�fe j�t� �';
<br /> 'for property described cs follows: -:
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<br /> Legol Deseription: 19th & 110th SE� }.yerott,:.'a. The Owner hemby oprse8.io ISp-tiqundp� d1 :;
<br /> rules ond regulatlons,'i�uw in forc� 6r as i�q1� ,.,
<br /> ;;tznaa^d OI.1 inafter umended, of the.5elwr Distrfct." , ';;
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<br /> , -11 �tera /.� ��'�,� ' �,e� �,`t
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<br /> Address: � ' ' i„-;
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<br /> ••-•..............••••....:._.....---•••--•-•-••........_......._...........•--•........ 21fi FoFFY Road �,. ,�
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<br /> Owner's Mnilinp Nddress'
<br /> Open cut rerr.:lt; ;;�SC.OG
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<br /> • Side Ser:�s� :tur permit ��.00 ...............••-•••-....._...••••...._.... ....._.. ,:ti:» �A
<br /> �ide �ewer pFr�rit (2; �C,00 BIIUng /lddress , �
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<br /> Contractor _ ..11:.T�:.��cP.�tr.:�.:nr...:.••---••••................_........ License No. _vL�..�.:'.�.wZ.�:�.l,l.� . ....:,t •�`
<br /> AftPr installation, the system shall be inspected by a representotive of the Distritt before toverlriq�. ''�'h�'prop• `�
<br /> erty owner shall be responsible tor oll opemtions, maintenance and repair of ths side sewer `
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<br /> Permit issued by: .....t�.l:ld./..r�....Gc'1 ..:.;C.Js�:t1��.........................•••••--•-- DPte i••:rL.�..�� _.��. t`�
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