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SIDE SEWER PERMIT <br />SILVER LAKE WATER DISTRICT <br />�,o_,�..�.�. <br />�.n, w.w�on �ua <br />�awt <br />u�� r 3 <br />' (t�3 0 � <br />The undersipned Owner hereby mokes opplication for a aewer cwinectlon to s�wer matro of tha DitMd; <br />for property described os follows: <br />Legol Description: <br />.-� ��7 �� . �'7�r;� , �� <br />�. �,�'/ C�C'!! J <br />�. ,: �uf/IC�, <br />``J <br />Address: <br />...�.��.�...........��5. � �...,�..L....�..t �.........�_.... ._. <br />.... �✓..1........... <br />+�� UO <br />COSt...........J.rl� ........................................................ <br />The Owner hereby opr�es to be bcund by oll <br />�u�ei ond repulatio�s, now In foroe or m hara <br />Inafhr amended, of the Sewer Di�frict. <br />� <br />..............{:...._'.....:'..�.........t....»..:....�.i :.:':...._..... <br />Ownet'� Slbnatum <br />.............................................._.... _. <br />;r:.,...��... J..�r. �m►a �ea� <br />r <br />i. li'!?'7'.�... {.. ..�1 ..................................................».. <br />.'....:: �. ............................ <br />- .:........... .......................... <br />- �. Billinp /lddress <br />Contructor ..................�.....................� .....'% / ....D.........Licenss No:.........._............•..>.�;� _.._...... . <br />After instaliation, the system shnll be ins ted o rc rosentotive of the DlstNct b�loro covtr� TM ProP' <br />erty owner shall be res nsible for oll rotio�s intenonce ond ropol► of the sld� Mnr�r. ..��' <br />Permit Issued by:........... <br />