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P - 75069. -�:� CITY Of fRIDLEY WATER AND SEWER �ONNECTION PERMIT APPl.1CAT10N �e: Dat �° 1 �� ( rrM OwrMr a Plumb�rl • , /�feSS: - _ ! O� G� �/R/(� � /�' DESCRIPTION SEWER�� FEE: '� BLOCK WATER! �� FEE:� METER: ��' � DEPOSIT: O-QAPTER: SURCHA GE: �SO SURCH RGE: � �D �7` TOTAL: 5��0 TOTAL: f��J U TOTAL: � a� V V GRAN� TOTAL: �' 4 � � � A.C. CHARGE ON EXISTING STRUCTURE: STING STRUCTURE: NEW STRUCTURf: LDING PERMIT No.: � SEWER/W�9,TE ER 0.: CIAL ASSESSIYIENTS: � Si � �i� _ B r�'�'v4r ��(/