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— - +/'�nU�f aa7rnW7PN�"`T'�..�-�-.....+-w.,r•ro <br /> CHART NO. ---V$—. <br /> " rJoo $ « Iq Pi '' rn <br /> PRIT. <br /> Sewer Application anA_ it.�. <br /> I .7 <br /> ?. ?r, •1 11 DATE 2-11-94 11 <br /> i <br /> Service Address '69 ' t'' t` ''t' _ Ulility Account No. <br /> Billing Address 14410 Bel si, d Rd #200 <br /> City, State, Zip nelle.•ue 1•A 99007 Permit Fee $ in,nn <br /> Owner countlrwood i'.nnen Connection Charge <br /> Connection by cu Trunk $ <br /> Address Lateral $ - <br /> Total Connection Charge $ <br /> Phone Utility Development Fee i <br /> Legal Description: Water $ 224.00 <br /> Lot 32 Sewer $ <br /> Block Powder Mill Highlands Div 2 Total Development Fee $ 224.00 <br /> Plat - <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E,W M' <br /> Type of Permit new connection Approved By <br /> Issued B MH <br /> Remarks Y i <br /> _. Customer Signature j <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> Inspection By t <br /> CALL 259.8810 FOR INSPECTION a iG y <br /> Date Inspected <br /> SEE SKETCH ATTACHED 2964 1 <br /> INSPECTION <br />