The URL can be used to link to this page

P - 74944CITY OF FRIDLEY �```� �� %� ✓ WATER AND SEWER CONNECTION PERMIT APPLICATION s (_' t� �� ' ��.� !c� LC r t_.-G.� �'"�� S Date: � " =-� 1 � (Home Owner or Plumber) Job Address: / % _`,�:.=� f�i? r ;r � � �� 2 � LOT NO. BLOCK T ACT OR ADDITION LEGALDESCRIPTION �,,.�/ � �C. �,,�J�� f;_�L ��`� PERMIT: � '�� SEWER: � WATER: METER:� FEE: °�� ' �U FEE: �� Uv DEP061T:� O-DAPTER: � STATE S� j STATE �-G j j SURCHARGE: SURCHARGE: TOTAL: °�'s S� TOTAL: �'' `'� ll`OTAL: � �3 GRAND TOTAL: �� ' S.A.C. CHARGE ON EXISTING STRUCTURE: EXISTING STRUCTURE: NEW STRUCTURE: BUILDING PERMIT No.: ��-"'� SEWER/W TER PERM,IT NO.:� SPECIAL ASSESSMENTS: �' � � ` Signed:,. J � � gy: �.. --, �,� 1 rt_� ,