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��� <br />ay � <br />r y <br />� � <br />H 7Otl <br />�Mhl <br />y <br />�o <br />�HC <br />��g <br />�V C�9� <br />�yH <br />H <br />� <br />��N <br />O V� <br />� <br />i <br />C� <br />� o <br />LI"1 <br />�� <br />Sewer Application and Permit <br />�,!� 29282 DATE 8'/O —�%� <br />Service Address �� � `-� �. v� U�iliry Account No. <br />n M�J �� <br />Billing Address � <br />City, Slete, Zip <br />Owner -- <br />Connection by <br />Address . <br />� Phone _ <br />Legel Descrlption: /- <br />i i / 1 � L o.� c• ..s 7�r c..J <br />Lot <br />� f' L <br />Block <br />Plet �1i � ! � r <br />Unpleped Descrlption: � "^ - ' ' �' °^� "-� <br />.vi r+ 4' d C a � /��L <br />Type of Permll <br />' Remarks <br />I �� _ <br />� <br />IMPORTANTI <br />CALL 1-800-424•5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee � _ _ _ __— -- <br />ConnecUon Charge <br />Trunk <br />f <br />Lateiel $ <br />Totel Connec'ion Charge $ <br />Utillty Devetopment Fee <br />wacer <br />seWa� <br />/ <br />Talal Develcpmen! f ee <br />Sewer Bond District _ __ <br />Abutting Lot L_ I�e-- <br />N, S, E, W <br />� <br />a <br />$_ <br />n. <br />Approved By — <br />Issued By� . �— <br />Customer Signeture ------ --- -- <br />1 <br />J���' �"7' � <br />Inspedion:9y v_ � '!��1:_ ___ <br />Datelns�fecle� ��--`--- <br />� CENi'RAL RECORD� <br />UTILITY BILLING <br />;�;° 29282 <br />