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P - 74962
� � � ., �,� . _ : .�� � _ �.; � GITY OF FR�OLEY �:�- �� i 7.� WATER A�ID SfWER CONINECTION PERMIT , APPLICATIpN INo� Owrwr � ) 5 5 ,5 �s� IEC�lI DESCRIPTION PERMIT: ,,. sewen: �.�, UC� FEE: � �— — � .� WATE R: � FEE:_�_ ' `� / 19 '> s � METE R: DEPOSIT: O.OAPTER: STATE �j � STATE �JfICHARGE: �` � `"' SURCHARGE:_�i„� � -� :.- , �;�� � p / ��J TOTAL: !'-}f J �- TOTAL: /� � � TOTAL: � � � � _ . _, l ,. , B�� o � � 6RAN0 TOTAL: j S.A.C. CHARGE ON EXISTiNG STRUCTURE: , EXiSTM1G STRUCTtlRE: NEWISTRUCTURE: � � �1NLDINC PERMIT No.: SEW�R ATER PERMIT NO.: BR�CIAL ASSESSUAENTS• _ Si 5 By: 0 ��