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P - 75030CITY OF FRIDLEY WATER AND SEWER CONNECTION PERMIT APPLICATION ( OIM UW � Of Job Address: � � LO�� LEGAL DESCRIPTION r'w� �*' T � �° ;�< Date: � " S 1 �,� _ D� C�% PERMIT: SENIER: ✓_ WATER: "'�- METER: �- FEE:� FEE: �S�U� DEPOSIT:�� O-DAPTER: SURCHA RGE:�� SURCHARGE: S v � TOTAI: TOTAL: `S ' � TOTAL: �D' vo GRAND TOTAL: �� E ON EXISTING STRUCTURE: !!� STRUCTURE: NEW STRUCTURE: ''� BUILDING PERMIT No.: S v SEWER/WATER PER� T� N�.:� �! �' SPECIAL ASSESSMENTS: Siyn�d:��li� /"`��'�'•-'�` � � _ q� gy; ,D�*-�