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P - 75014�,ux�:g,�} rt�;.�ia„�'< �� q 4, �' . :�� CITY OF FRIDLEY WATER AND SEWER CONNECTION PERMIT APPLICATION ; _ �vr%- Lc.c ND �v�n �s (Homs or Plumber) �..�• l�S� C�a S � �-�. �v v ✓ Date: � —�S 192'�_ . DESCRIPTION I � I / ��(5��-�0� ( IT: / SEWER: �/ WATER: ✓ METER: FEE: a�"�� , FEE: �� DEPOSIT: O-DAPTER: STATE SQ STATE � SURCHARGE: SURCHARGE: TOTAI:�"'= TOTAL: �� J O TO7AL: � ,�� oa GRAND TOTAL: CHARGE ON EXiSTING STRUCTURE: ING STHUCTURE: ._NEW STRUCTURE: ING PERMIT No.: °"� SEWER/WATER PE IT 1� ASSESSMENTS: Signed: � gy; r—�i��_--�..