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� <br />SIDE SEWER PERMIT <br />SILVER LAKE N'ATER DISTRICT <br />as�o - e �sna s�. s.e <br />Enm4 w.�Miq�en N10e <br />l37-fMt <br />, uu:�,' �� <br />�� a <br />The undenigned Owner hereby makes epp��cat�on for o sewer connectiort ro sewer moins of the Dithl�t; <br />for p�operty descrfbed as follrnvs: <br />Legal Description: <br />�V 1 3 �J�f-l'��t�,rin 5�{� <br />�; , l tl-Pl' Uc � c S �'� .i1,_, p( y� � <br />Address: ` <br />� -I �, � _ �, S <br />.....�..�..l�..........1.I....) ............:.? J.....,.J... ;......._. <br />� ,- .......... <br />_ <br />.....�,......�..A ...................................................... ,. <br />�� <br />Cost ......... J.::7..(� ................................�.:. <br />................ . �,: � . <br />"�' <br />The Owner hercby aprce� 1u be bound bY all <br />irwher ome�ndedtiof tha SewertD shictos here- <br />...............�..... 1�rxrs Sipnal�uro.:... �.�..::�...... <br />.................. �...... <br />................................................ _. <br />...................... _.. <br />o�r� wwm�o �,ee� <br />� <br />..:.... ............................................._. <br />r .................ennny �ddres. <br />' ��•:a <br />Cont roctor ............................ .................................................... . <br />......Licenid No .........................••••..............••-...._...... <br />After installation, the system shall be inspected b� a representotive of the Dlstrict before cove�lnG• Th� ProP' <br />erty owner shall be responsible for pll operotions, mol�terwr�� o^d repalr of the tide sewer. ,:. <br />/ / / -- l 1: �� .:.... ........ _... .: <br />. , l...1..6,(.�........ �llL.(..t ..........................................Date:.......... .. . <br />Permit issucd by :.................... ; r� <br />f�.,,. .... <br />