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P - 75064
�;�.�r. .�,., 4; ....,�..,��, ��„�..�'�}te . .:;�µ,�� �t�^��; c N'-��, s ,�'�, - „�i I ,� r�� � °� CITY OF FRIOLEY � I� WATER AND SEWER CONNECTION PERMIT ( APPLICATION , Nsme• �.,J�(% i1?"� Date: � -/.Z 1��i_ .IOb /�dfe�: /� __.. ..�_ IEGAL���DESCRIPfION �AMIT: SEYYER: ''— s ,:� . �. FEE:� I"' WATER: FEE• ��` 00 METER: DEPO6IT: O-DAPTER: 8TATE � v STATE S� SURCNARGE: SURCHARGE: TOTAL: � `S� TOTAL:� TO�AL: , �l "� GRAND TOTAL: S.A.C. CHARGE ON EXISTING STRUCTURE: EXI$TING STRUCTURE:._ NEW STRUCTUflE: BUII�DING PERMIT No. � SEWER/W E�IT NO.: SPECIAL ASSESSNIENTS: Sipned: Y�