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P - 749297��� �� �t,_ . . � , H'ti � � ; . . � CITY �F FRIDLEY WAT�R A►ND S►EWER CONNECTION PERMIT APPLICATION � y �''� ✓ Nae�w. / f- t D:" 1 i I-� a� ^�(,J �-' r� Qate• ��� U • (Monr OwiNrr,o► Mumb�r) � — .IOb��fNt: �P`-., �,��� � i� �� :.�C. �, �.: / � � NO. �I,OCK ,. TRACT O!1 LEGAL D�CRIPTION . ` (c /� ` L 1� ,� i� �� :�,��` PERMIT: / 8EIA�11: �- WATER: METER: ^� �' �— FEE: °`_�' U� FEE: �`-' ' �U OEPaBIT: O-D/1►TER:...._._ s'TATE �v 8TATE j U SUlICNAl1GE: ' SU�CHARGE:_.T_ TOTAL: °'�rt. U TOTAL• �`'� � `' c. � J �/ / GRAND TOTAL: ` 19 9�_ ' E�3E QN EXISTING STRUCTURE: NG �TRIlCTURE: NEW STRUCTURf: MIII.GtN6 PERMIT No.: ���� _SEWERMIATER PERMITJdO.: 9�'� .� �EqAL ASSE&RIfAEN'T'� � � � � Siqn�d: �- •" .9i•" J/ - � ; � g��? � , , ,.�. s.. _ _— �