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P - 74982
Name• � _ __ __ ,y- ` CITY �F FRIDLEY WATER AND SEWER CONNECTION PERMiT APPLtCATtON (Hortn Ow�r o' Plumbsrl �� �7�� Date: 3'� 7 tg_ `�Y , LEGAL OESCRIPTION I(�' // ' a^ �••••••� v� r►vv�ir ARtna /AIfP J pr� RERMIT: , _ l.�9�cE�3'�.�.c_ SEWER: C/- WATER: �_ METEFi:�_ FEE: �S � FEE: /� DEP0617': O.-DAPT6R: STATE �- STATE �V. SURGHl1RGE: � SURCMARGE:,_.�_ TQTAl:___ TOTAL:____�; TO'iAL;:_,.,.r.__.. GRANp TOTA�: y� ¢� S.A.C. C#fARGE ON EXISTING S'FRUCTURE: EXISTING STRUCTURE: NEW STRUCTURE: BI�ILDING PERMIT No.: SEW�R/WATER PERMIT Np.: �19�P SPECIA� ASSESSMENTS: � � Si�ed: 4���'`n�, ��,�,-�deo-,'1 ��+y�> ey: ,� -