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P - 74976,y �,^;� ;w �.�. ..� ; ,; �"� °� a .� �`= �F:%'� '° .� "a CITY OF FRIDLEY � WATER le►ND SEWER CONNECTION PEFMAIT APPLICATION �Fbm. owMC o.Mumb..) .� �: , ""7� �� LEQ/1l QESCRIPTION �OT NO�}., %%lo. 15f.. / � P�AMIT: Date: f,° SEYYER: �_� WATER: FEE: �� • �Q FEE: /J . � TD %�•UL� METER: DErOBIT: O.OAPTER: 8TATE �� STATE ,� D SUNCNAIi4iE:,=.�_ SURCNARGE: TOTAL: �� TOTAL:�-'Lr� TOTAL: 19�.._., � ��% ' .�RAND TOTAL: "7 I. UU S.A.C. CHARGE ON EXISTING STRUCTURE: E7�ISTIWt3 STRkJCTURE: NEW STRUCTURE: BW LDINCs P�RMIT- No.: °2� Sw� �' SEWER�ATER PE IT NO,:� S/ECIAL A�YIENTS: �C g• ..� .a ./v � �_ � G—c�3--9� B�� � _. , . ; - , - ., Y•— ti _, � � . � p.