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CHART NO, - --- <br /> TQ PMT10 9L <br /> .h3 <br /> G H N M J <br /> a � � <br /> HEM Sewer Application and Permit � 4 <br /> n <br /> V " r ? :� ' ' i DATE : 4/6/93 <br /> d <br /> Service Address lh 59th PL SW Utility Account No. <br /> H� Billing Address 297 lav st <br /> H <br /> y City, State,Zip Lv,r tt Wn nsana Permit Fee $ _ 70.00 <br /> I <br /> Cn Owner ^e}eeE RUP&OR Connection Charge <br /> ti <br /> H ' <br /> n o rn Connection by !7G Trunk $ —- <br /> � r — <br /> y y Address Lateral $ <br /> H O En 0.00 <br /> i Total Connection Charge $ <br /> Phone _ Utility Development Fee <br /> I <br /> Legal Description: Water $ 179.00 <br /> 1_ Lot 41 Sewer $ <br /> i Block Total Development Fee $ 179.00 <br /> Plat tlanrbrook Div 3 <br /> �T ULID Y1 i <br /> Unplitted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E.W fL <br /> _ Type of Permit ;o, .. Approved By <br /> Remarks Issued By B <br /> Customer Signature <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> Inspection By r'�st�P�f�lw <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected <br /> SEE SKETCH ATTACHED <br /> INSPECTION 29141 <br />