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P - 75051
,..:ia;�__`:3�"t�y}` .. .�.: � , .:.:::'�Si�'pa;�.'� `a "�I°�.:�-: ��`��'�i' .�� a�;S*{.s,_,r�, � � ��{- °"3 , ,. � . *a?- J.�jj �'a�13 �� /f ' F3 .J� CITY O� fRIDLEY �� y j �"'� WATER AND SEWE� CONNECTION PERMIT APPLICATION Name:_�d � / �C �c.J1� �?�S Date: �a /O (Hoan.°�j o. � mb.�t: ,�ob �►dd�s; ,_ �a � [ '-�� f S 7�X�S0 � �,oc.�� LEGAL DfSCRIPTION � � ' �/� � �.S/�/�-�..�ON � PERMIT: �� BEYVER: ~' WATER: J' METER: ✓� FEE: �S UO FEE: ��' �� OEP061T: ��- 40 a��R: aIJRCHARGE: �y ��-7� SURCFUARGE: �� TOTAL: °��'� u TQ[AL: �S' � TOTAL: "'� - w �/ / °� GRAN� T�TAL: 8.A.C. CHARGE ON EXISTING STRIlCTURE: EXISTING STRUCTURE: NEMV STRUCTURE: BWLOING PERMIT No.: °? S�� ,._SENlER1W R PERMIT : t � SPECIAL ASSESSMENTS: $ip�d: � �. � • gy;