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'i <br />r <br />® 8es88�8 8 88� <br />Sewer A °' <br />pplication and,PQrmit <br />pj^ 2 n -) 42 DATE 2/9/94 <br />Service Address 126 Blot St SW <br />Utility Account No. <br />Billing Address 20541 NE 150th <br />City State Zi Woo ti 111 <br />CHART NO. <br />TO PO1TlNG_��1�L <br />p ny a 9l3072 Permit Fee $ <br />Owner Jerry Ilicke <br />n Connection Charge <br />Connection by G rNt " N 5 Trunk $ <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />Lot 2 SP 95-90 <br />New conneciton <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />$ <br />Total Connection Charge <br />9 <br />Utility Development Fee <br />Water <br />$ <br />Sewer <br />$, <br />Total Development Fee <br />$ . <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E. W <br />Approved By <br />Issued By <br />Customer Signature <br />Inspection By 7c�f'�.,, a- <br />Date Inspected <br />70.00 <br />M <br />179.00 <br />471.00 <br />650.00 <br />0 <br />INSPECTION '. 29642 <br />ft. <br />