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P - 75066� �� y��� �.���' f��i '��.�Y`�i�k`�+��A''`:'�� � aL+`t ...- . . . ' . . . �G: . � . . .. ��. . ��. ..., % CI�Y OF FRIDLEY � WATER AND S�WER CONNECTION PERMIT APPLICATION �F# 'S�� . .. J� Date• � ' � � 19�„_ � ��; /�� �-�2,�s��1s�� � ., LEGALDESCRIPTION ��' BLOCK !�/ / _.-_. _ s PERMIT: � SEWER: � WATER: - FEE:� FEE:� O•DAPTER: � "� � � s� STATE STATE SURCHARGE: SURCHARGE: TOTAL: � � TOTAL: �"� ' � $`,�,,% / UU GRAND TOTAL: � �/,I/I' . � .. �.!�i������,► TOTAL: S.A,C. CHARGE ON EXISTtNG STRUCTURE: EX�TING STRUCTURE: NEW STRUCTURE: BUILDING PEflMIT No.: �- ��� SEWER TER PERMIT 3 8P6CIAL ASSESSMENTS•.d.�t.� Si�rNd; L _ . ey. �/ "�