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P - 75042Nams: �� ��'",*:��iRS .b . � sFe. �y' tr�� ::_.`�' . s?�t�r�"':,-,�. '�"' ?' s �',.""�°a"w�t �;u— . �: "� / ` CITY OF FRIDLEY WATER AND SEWER CONNECTION PERMIT APPLICATION � �,� �. a � LEGAL DESCRIPTION PERMIT: , � �� �_ SEYVER: FEE: ` UV so�.1 �� Date: �� —�S� 1 a� I � WATE R: METE R: FEE: ` �' "'`� DEP061T: }' vU O-DAPTER: STATE —� STATE S� SURCHARGE: -7� SURCHARGE: TOTAL: —' �" TOTAL: /� TOTAL: v"" "`� GRAND TOTAL: �/D/ �U S.A.C. CHARGE ON EXISTING STRUCTURE: EXISTING STRUCTURE: NEW STRUCTURE: BUILDING PERMIT No.: � SEWER TER PERMIT ' � SPECIAL ASSESSMENTS: Sip�ed: L.�LI.� r� sy: ��'