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' n�t e y— /3��� <br />� � N_� ��rt��t <br /> APPLICATION <br /> Deferred s� wer Connection Char�es <br /> Applicant : �v==�'�TT ��ll�/] �SS'�C/�Q�C -j` <br /> Address : `S-c9 - //� T.� vf: .c, �St�iTz�' �jo <br /> ,FLcE'duE� c-r/i�9�ov� <br /> Site Address : �a�a /� � �-,tc,�l�— <br /> Reference: Ordinance I�o. 1135-85 allou•s defei•ral for amounts in <br /> excess of 55,OOU for a period not to exceetl six (6) <br /> months . <br /> Total 5e�cer Connectior, Charge � �SSS/=2 �� 538-3C�8-26 <br /> PaS�ment Deferral Fer� 5 50.00 002-5«-4C-000-1;-831 <br /> Sub Total � �SI�z,Z,� <br /> Less Inspection Receipt. �o. d � �03 S - o Sc� —� <br /> Deferred Balance $ .,SO,_;/�� �>3s-12Z-10� <br /> Date Balance llue: �����'f� /-� ,/'y�� �Kc�yp>6� <br /> .1'O'1'E: lleferred �alances that exceed �50, U00 �A�ill re�uire a current <br /> title report and mailing address ior all parties listed on <br /> the title report . <br /> t <br /> . � � _ <br /> v � <br /> horizai:iori <br /> cc: Accounting <br /> City Treasurer <br /> � <br /> /R!(eNl �fY�t�. <br />