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P - 75068�,..�. .�''�X'%�`�"e��`a�M�. . . . ,• A:q.lTsi'y'�3:'A'j�;''�",x`'v."�'p�^yc� "'SYs}+'r.+:� i.-j �S,r. :F.. ��_3� - . . . . .. � . •. . . C1TY Q� FRIDLEY �/ ..„� WATER AN� SEINE`�i CONNECT101V PERMIT `��' �`J! APPLICATI ON � Nsme: Da#e: tHom. own�. o.'twn6..1 Job A�d�'.n: � �1a�� -" " .� LEGAI. DEiCRIPTION �' B OCK TRACT OR ADOITN � � PERMIT: , � SEWER:� WATER: I�•OV METER: ��1 � FEE:� FEE:� DEP061T: 0•DAPTER: STATE ��,,�— j�_ STATE 1��O SURCHARGE: 8URCHARGE: TOTAl4�`� •� TOTAL: —" " � TOTAL: � � � � CsRAND TOTAL: �' O�� v v S.A.C. CHARGE ON EXISTING STRUCTURE: EXISTING STRUCTURE: NEW STRtJCTURE: BUILDING PERMIT No.: SEWER TE��� .i��� SPECIAL AS6ESSMENTS: giqwd� /�''�''t�`'�'7 ey: _ +,�;;_