Laserfiche WebLink
.. j^1YVFi`-J'}M:'�_�MVF��.�fi���'�A'.ii-!4t�R.�-'�.M-: <br />]4 <br />�J <br />� <br />�i ; -�� -, <br />� �- <br />�, � ,: <br />Sewer Application aRd Permit <br />�LL <br />r.,��-u�, <br />;." 29646 DATE 2J11-945 <br />Service Address 1522 112th St RE <br />BIIIing Address <br />City, State, Zip <br />pyy�g� Deln Nancock <br />Connaction by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatled Gascription: <br />[ <br />Type�)IPermlt n�w cnnnection <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />Utllity Account No. <br />Permit Fee $ <br />Connection Charge <br />CHART NO. <br />TO POSTING 3 -z�-q� <br />70.OU <br />Trunk <br />Lateral <br />Total Connection Cherpe <br />Utility Development Fee <br />Water <br />Sewer <br />Tolal Development Fee <br />Sewer Bond Dlatrict <br />Abutting Lot Line <br />N, S, E, W _ <br />Approved By — <br />Issued By <br />Cuatomer Slpnature <br />$ <br />$ <br />$ <br />$ <br />a 400.00 <br />� 400.00 <br />u"� <br />Inapection 8��,,,,��������� <br />Date Inspected ,� �� '3 ��� <br />� � � <br />SEE SKETCH ATTACHED <br />INSPECTION ! ': � 9 ( 4 �j <br />