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CHART NO. <br /> TO POST"''' Co-CL z�-9 <br /> 8888F8 8 888 <br /> n .n ': � <br /> N M - <br /> Sewer Applica#id"In an i <br /> 5y� 7rr- kk <br /> oES� � <br /> 29 f DiVrl�/1/D3 � G <br /> 2506 57th St SN <br /> Service Address ---- Utility Account No. <br /> Billing Address 14410 Bel-Rad Rd _ <br /> City, State, Zip _ Belles?e LM 985207 Permit Fee $ 70.00 <br /> Owner Cn„,.JC and 111nmom Connection Charge <br /> Connection by ate./i • .L_ _ Trunk $ <br /> Address ____ Lateral $ <br /> Total Connection Charge $ -0 <br /> Phone Utility Development Fee <br /> Legal Description: Water $ 224.00 <br /> Lot _ 27 _ Sewer $ _ <br /> Block _ Total Development Fee $ 224.00 <br /> Plat Powder Mill ilitthlands <br /> Unplatted Description: _— Sewer Bond Di,-trict ULID Al <br /> Abutting Lot Line <br /> N, S. E, W ft. <br /> Type of Permit Naw connection Approved By <br /> Remarks Issued By gb <br /> Customer Signature <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED <br /> INSPECTION 29435 <br />