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P - 74931/ CITY OF FRIDLEY ,(�-��'/ `�3�''�'/ �� WATER AND SEWER CONNECTION PERMIT APPLICATION Name: Jerry � s Plumbiny Date: �-�' '�� 19`32 (Home Owner or Plumber) Job Address• 3�» F.ast �iver �d ,,1E LOT NO. BLOCK LEGAI. DESCRIPTION Pt, of 20 Aud. Su.'�. #103 PERMIT: SEWER \ WATER: n METER: � FEE: �• FEE: l�• �0 DEPOSIT: 00. 00 O-DAPTER: �' � STATE ,�"Q STATE .�U SURCHARGE: SURCHARGE: TOTAL: TOTAL: 15.50 TOTAL: 6�'�� GRAND TOTAL: 75' �� S.A.C. CHARCaEf3N EXISTING STRUCTURE: EXISTING STRUCTURE: NEW STRUCTURE: BUILDING PERMIT No.: SEWER/WATER PERMIT �•#�� SPECIAL ASSESSMENTS: �Q ��- Sign , ��` � _" c�, : =k "�' " BY:� '�°-�r "�. � �; 1 �,�,� _,�.I'� „� e