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ynH <br /> � � � i-._.—.._.....------- --- ------ --_----- -----_. _ . .. _- -- - - --. . . _ . _---._ .. . . _----- -- ----- -.._.._� -- - <br /> a �. <br /> � y y Ci-IART NO. -- — <br /> � 1, <br /> H � E�-+ .�, `�. <br /> oxo I 3�3� �3 <br /> � z � ! ��, � TO POSTING —��� <br /> , � <br /> � o <br /> oHd � <br /> aH � �, Sernrer Appiication and Permit . <br /> ryz � <br /> H H .� <br /> � �' H i r. 3� '; , DATE .i����. i_>, it,�,z <br /> otyv� � <br />� �� � � Service Address �732 lOth Dr SE Utiliry Account No. <br />� y ��' I Billing Address —�13 Se �v ,'n]_'-Iay <br />� I City, State, Zip t:verecr. Wn 9a20& _ Permit Fee $ 70•00 <br /> �� <br /> I i f.-urd[: i1n;�„a � <br /> i <br /> Owner Connection Charge <br />� ii Connection by <br /> ct.n;cr Trunk $ 3's�i.r,n <br /> i 39;.nr <br /> � Address Lateral $ <br /> Total Connection Charge $ 7''•��� <br /> i <br /> Phone 353-650e _ Utility Development Fee <br />� LegalDescription: Water $ 179•��� <br />�� � � � � LOt 1 oi hiounCr,i❑ V.ic�: l�i.c. 7 SeWOr $ 47L90 <br /> I I � — <br />; ��� j Block Total Development Fee $ 55U.00 <br /> � Plat <br />� ;a' il <br />� <br />� �,r' ' Unplatled Description: Sewer Bond District �i' <br /> I <br /> ��� � . Abutting Lot Line <br /> 11 ' N, S� E,W ft. <br /> � � <br /> � ' Type of Permit t�•:�: conrieccion Approved By <br /> 1�' Remarks Issued By �" 1 <br /> Customer Signature ' <br /> � <br /> 9-� I IPJIPORTANT! ' <br /> "' CA�L 1-800-424-5555 48-HOURS � <br /> ' ; PRIOR TO DIGGING � J / . <br /> CALL 259-8810 FOR INSPECTION Inspection B� <br /> I Date Inspected ,� �/`j�— <br /> SEE SKETCFI A'R'ACHHD <br /> � INSPECTION � �' �% 1 � <br /> I <br /> i <br /> i <br /> � <br />