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��� ,1_ .. ... . . _ . r I . <br /> y�� CHART N0. _- ___ __ - <br /> � <br /> re c� <br /> �C�intl <br /> y <br /> ��� m PosriN�__�_3/ -43 <br /> ��g <br /> �y� Sewer Application and Permit <br /> MH <br /> gdy � �0 ��:'. DATE t/:v/s� — — <br /> ��y Service Address �14 lu9u: st sr. Utility AccounWo. -- <br /> Billlnp Address Szme <br /> Qlly, $I810,Z�p Iv rntt GA 9A2(1R PBfR11i FQ8 $ _. j�•�%�� <br /> Owner `JaCi.iwu Ysawot Connection Charge <br /> Connectlon by Trunk � <br /> Address . Lateral $ <br /> Total Connection Charge S <br /> Phone ___ Ulility Development Fee <br /> '�� Legal Description: Water $ <br /> O ' Lot Sewer S <br /> w <br /> Block Total Development Fee $ <br /> i i Plat _ <br /> Unplatted Descdption: Sewer 8ond District — L I 1� 7,{�1 <br /> ; Abutting Lo�Llne <br /> N,S, E, W h• <br /> �� Type ol Permit Nev connoction Approved By <br /> O� RemArk9 _ Work mue� comc:ence ��Slhln in GO IssuedBy <br /> '_' �1ny�w [�( 1aw�unrn n: t' Sw �L�n1r OUSIORIB!Signature — � <br /> �� IMPORTANTI <br /> —' CALL 1-900-424-5555 48-HOURS <br /> �I PRIOR TO DIGGING , � ! / " <br /> Inspection B�l.�c�.,n�j� /-�/ G,/ <br /> CALL 259-8810 FOR INSPECTION 3i��T� r�— <br /> Date Inspected _�� <br /> SEE SKETCH ATTACHED <br /> , , <br /> ir�;i�i criord <br />