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P - 74975
:.. ;' .g � � : ;; ,. ,,, _, .:. , .. ,< :.:.,, ._ ., . „�. .,�;,.. �... .: ..,.�,..;�� . "+. ::> %: _ �: .:; . . . . . ��,.;_.. .;�,; "ci1g;' ., . . CITY OF FRIDLEY WATER AN� SEWER CONNECTION PERMIT APPLICATION �Hom. ow�.. o. .�Ob l�f6fi:_ LEGAL DESCR{PTION PERAAIT: � SEYYER: .��_ FEE: �� Date: '• ' � �� 1 g� WATER: "- AAETER: "'�- FEE: ��? DEP061T: • �G� O-DAPTER: SURCMARGE: , �v 8URCH RGE: . �� TOTAL:� TOTAL: �'��� TOTAL: �t•��� GRAND TOTAL: �.f 0/ G`� SA.C. CHARGE ON EXISTING STHUCTURE: EXlSTING STRUCTURE: NEW STRUCTURE: � �SJILDIt� PERMIT No.:�7� : SEWER/W TE PERMIT NO.: lI�ECIAL ASSES ENTS: ' �ZCE x: :1. f-, � Sqned: � Y'- '� ��Zl.