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P - 75045�ITY OF FRIDLEY WATEI�AND'SEWER;CONNECTION PERMIT � :APPLICATION �L-- �f i � (Hom� .bb Addreu; 83a0 LEGAL OESCRIPTION � w Plumb�r) �_ /�flL� ��f�� /S ' `� �� K � .-�„-�..,.-.�.,-., � d�_ f ��;�3 Date: �� "a� 1� I PERMIT: � SENIER: �� NMTER: �� METER: i� FEE • �S � FEE • �S � DEP061T° �Q� O-DAPTER: STATE S v STATE � O SURCHARGE: SURCHARGE: TOTAL: �� S� TOTAL: �S' s� TOTAL: D• OU �t U GRAND TOTAL: /�/ D� n� �oU / S.A.C. CHARGE ON EXISTING�STRUCTURE: ' EXlSTING STRUCTURE: NEW STRUCTURE: BUILDING PERMIT No.: SEWER/W R PERMIT NO.: �� SPECIAL ASSESSMENTS: S' �� 1�'� ` (� �` ��