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; : � : �,...� V"1 <br /> Date �6 tvo. /Q�� <br /> APPLICATION <br /> Peferred Sewer Connection Charges <br /> O�.mer �1�v �GJ � C�vY,��'f/l�y _ II <br /> Address ��o /o�'Tis' ST.E2z—i �� �_ S�ii,'Z= <br /> /of <br /> _ �i��� �t�� ����� <br /> � <br /> Site Address: /Sao GVE�T �'�i,('/�t� �'v��' <br /> .��G��'�i i c��� <br /> Feferencc: Ordinance Ko. 113�-RS al;ow�s deferral for amoimts in escess of <br /> $5,000 for a p.riod not to exceed six (,6) months. <br /> Total Sewer Cormection Charge $ -�-� ��` �--`� 338-365-26 <br /> `7— <br /> Pa��nent Deferral Fee $ 50.00 00?-322-40-000-17-R31 <br /> Suh Tctal � y3 G�a �-� <br /> Less ra��nent �.30�? ' <br /> Treusurer's ReceipL �o. �3v 7S'' $ - 5050.00 <br /> Deferred B,.lance $ ��?�;32=—� 338-I22-10 <br /> Late Ealance Pue: ��� � <br /> I�OTE: Peferred Balances that exceed $50,000 Hill require a current titla <br /> report and mailing address for ali parties listed on the title report. <br /> _�' <br /> C�.ty Aut� riza ' n ' <br /> i <br /> cc: Accoimting - Application and Covenant <br /> City Treasurer - Application w/Treasurer's Re��ipt <br /> Build:ng Dept. File - Application and Covenant <br /> City Clerk - Original/Recorded Covnnant I <br /> 10/85 I <br /> 0147H <br /> I _ <br />