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e^j""---�-'�.�r�+^s+�n-�a-^--•--�.---,- -. ..-�-- --,-,�-j - --- -- <br />i � <br />, <br />%;� —�, � -::-. :' <br />CHART N0. —__ <br />TO POSTING ����-� <br />�% �-. , - _ <br />, , <br />. � , <br />,,:,,; - :;; <br />� , . .. - :� <br />Sewer Application� and Permit ; '�� <br />: .: ; <br />.. _ : . . _ ., <br />.. .., ..� �.' � "' ' _ '. �_ .. .. , rJ <br />� 9 � � � DATE :,�. _ - . . ._ . l� , <br />Service Address �%; -` � ��•. / ., , ,_ <br />– ' Utllity Account No. - <br />i. i r V / <br />BIIIing Address ' � � � % % L '��'(_ <br />�� ' � � <br />Ciry, State, Zip � ` � , �' % , «� ' <br />Permit Fee $ . (-� �� <br />, <br />Owner - � ��� � �" �/ �' ) % - — Connection Charge <br />� <br />Connectlon by Trunk <br />Address Lateral <br />Phone <br />Legal Description: <br />Lot _ <br />Block <br />Plat <br />Unplatled Description: <br />Type of Permit 1 � ,- �,' 1; , ,• ! � - ; <br />Remerks _ <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />C4LL 259-8810 FOR INSPECTION <br />- --- • � <br />SEE SKETCH ATTACHED <br />Total Connection Cherge <br />Utllity Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Gond Dislrict <br />Abutting Lot Lfne <br />N, S, E, W _ <br />Approved By _ <br />Issued By <br />Customer Signature <br />0 <br />� <br />� <br />Inspection By C� � �� ii � �-.r <br />Date Inspected �y I�, <br />INSPECTION <br />� <br />''9679 �' <br />