Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
P - 75061
� �r ?�''I j,' �{ �+A'�:, d' _ .+���.'.; c .F„_ � . � s.+7S;.'' �, � _ ' . � . . � � ' C�TY O�F� Rf�IDLEY WATER��►ND SEWEfl CONNECTION PERMIT APPLICATION Nsme: �O � i LC.( l (Harr Jab A�ddreaa:l� � ¢fo m�s or Plumb�r) ? � S � f-�So�J Date: � " � � 1 �lj ___ �C-F.%Z0 LOT O. • BLOCK TRACT OR AD�ITION LEGA�DESCRIPTION � - / ��,�Sr�l�SU�v PERMIT: SS�� SEYYER: � WATER: �' METER: � FEE: �� FEE:�S' � OEPOSIT: w• � O-DAPTER: STATE �'� STATE s�j SURCHARGE: V8URCHARGE: TOTAL: �� S� - TOTAL:' _``" TOTAL: �- oa �/ 00 GRAND TOTAL: ` D � S.A.C. CHARGE ON EXISTING STRUCTURE: EXISTING STRUCTURE: NEW STRUCTURE: BUILDING PERMIT No.: S � SEWER TER PERM T NO.: SPECIAL ASSESSMENTS: Siyn�d: /�� � /V� By: �s�.'y -- .F' /O /5�