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P - 75062
.�'" ti�v;.a:;jr�: atic�"L._;� ;��k%.�. �.'���'Yl�a�d��..1�ww.. ..,.r�F � � :.. .: .. . . . . . . � � ..' . . „ . 1 .. .. .. . ..�.. CtTY� OF FRIQIEY WATER AND SEWER CONNE�TION PERMIT APPLICATION IHonM OwnN LEGr�tk, DfSCRIPTION � �� PERMIT: �� SEYYER: FEE•� UO � . � �� WATER: ��_ METER: "r� FEE •/�± V O OEPOSIT• O O-DAPTER: STATE S� STATE � SURCHARGE: SURCHARGE: TOTAL: �' Sv TOTAL: �� S v TOTAL: ��- � GRAND TOTAL: �/�! U � � S.A.C. CHARGE ON EXISTING STRUCTURE: � EXISTING STRUCTURE: �7--- NEW STRUCTURE: dU1LDING PERMIT No.: ` SEWER � ER PERMIT . SPECIAL ASSESSMENTS: i�ned; L"- v B�: �