Laserfiche WebLink
y � ICHAR' NO. <br /> �" .i �a <br /> q ' H <br /> N J <br /> � � ~ � I� <br /> y � ,� I <br /> � y M I <br /> � � � i Tl1 r^�*�yr ._., ��— <br /> � � Sewer �lpplicatia� and Permit i <br /> M <br /> � � :. �� �, i , p g <br /> N ' . . �M1L ' ..� /..n� _ .. __. . .__.. _ — . . _ __ _ ' ._—___ <br /> H <br /> � O VI _ _--. ____ ... . <br /> � � � <br /> Servica Address _— � `" � -- Utility Account No. --- - - <br /> � N ❑llin! <br /> Oilling Address — - <br /> Cfty, State. Zip I:varat t wA 9H708 _ _ Permit Fee $ . . __. .- - _ —--.-_--.- . <br /> Owner — ! •�rry urey��r Connection Charge <br /> Connection by _�'��tdy Jnhnm,r Trunk $ _.—_------ <br /> Address Laleral $ -- <br /> _ _ Total Connection Charge $ _ <br /> Phone _ _ _ Utiliry Developmen�Fee <br /> i <br /> I �'�� Leyal Description: Water $ __ <br /> � <br /> Lot _ _ Sewer $ — <br /> `,� �.on <br /> t <br /> � ,—�1 Block _ - Ta�21 Development Fee K __ .__-_—__-- <br /> �� <br /> Plat _ - <br /> Unplatted Descriptlon: Sewer Bond D�sirict _ _ — <br /> � '�� Abutting Loi Line <br /> _ _. N�S, F,W --- fl. <br /> ��� <br /> ,� I Type ol Permit '� c:rr; �;r.r,T��� ; __ APProved By-- <br /> Remarks _ _ Issued By <br /> J tw'_� _ Customer Sl�nature-— — — <br /> � IMPORTANTI <br /> I �� CALL 1-800-424-5555 48-HOURS <br /> \ PRIOR '�O DIGGlNG � � <br /> -�'� � s-_ i� 'i <br /> Inspection By � / ��-c�=�i.�/-- <br /> CALL 259-8810 FOR INSPECTION � <br /> Date Inspected 9 '— p�- <br /> SEE SKETCH ATTACHED <br /> udsi�Fr,rioN <br />