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WWI IMP Y1 4 <br /> u CHART NO. — <br /> 3, <br /> TO NOSTING_� --2�-cl�� <br /> � � s��7� s � �pps snppss � � <br /> Sewer Application and Pgrrit ,. " <br /> 29! 50 (l -,PATE 2/15/94 - <br /> .\n <br /> Service Address 2629 57th St SW Utility Account No. <br /> Billing Address --14410 ],PI-Pad Pd 17n) <br /> C(ty, State, Zip u "• s+o—980ni Permit Fee $ 70.00 <br /> i <br /> Ownereet"Itty-eadConnection Charge <br /> Connection by �iPJ Trunk <br /> Address — Lateral $ <br /> --- Total Connection Charge $ -0- <br /> Phone Utility Development Fee <br /> Legal Description: Water $ _ 224.00 <br /> Lot 39 till Powdarmili Liv 2 _ Sewer <br /> $ — <br /> Block _ Total Development Fee $ <br /> Plat <br /> Unplatted DP;cr(ption: Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E, W <br /> Type of Permit New connection Approved By <br /> Remarks Issr-)d By _ eb — <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-800.424-5555 48-HOURS <br /> PRIOR TO DIGGING �- <br /> CALL 259-8810 FOR INSPECTION Inspection By_ <br /> Date Inspected >,x <br /> SEE SKETCH ATTACHED <br /> INSPECTION 2 .ri (I <br />