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P - 75019. . , , ,. .,e: ��. ,�:f. , :.. M. « r , >. - ,� : � , �. . . � CITY OF FRIDLEY � �, WATER AND SEWER CONNECTION PERMIT �,: APPLICATION �: �%i9/ °s-- y /u � • ,� y Date: `3 " 19 � ? �' IHorr» Owrnr w Ptumb�r) Jcj► Add�ess: �SG L'�iQ f"�a-� f'e--�- �Tl DESCRIPTION I �o�NO. I ��K I��7G S o� / �iMIT: � � ' C.�LC)SS/N� ' SEYYER: WATER: METER: `' �, FEE: FEE: DEP061T: R�; O-DAPTER: � � p /� �`" STATE STATE ^^� �,11(� SURCHARGE: SURCHARGE: � � � 1� � � TOTAL: '�"�' '�`� TOTAL: /J • "'"'' TOTAL: � �� GRAND TOTAL: '7 / � CHARGE ON EXISTING STRUCTURE: STING STRUCTURE: NEW STRUCTURE: LDING PERMIT No.: SEWER/W T��iT NO.• �9 87 CIAL ASSES9MENTS. � Si�ned:� ''j�`�� $y; U�9//-e� /�.h %.y�'o