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P - 74974
� : . .�. : ;�;�- ,ix x s:.-;� . . : . s.. i �s+ +;r :. . .. _ . - ' . ."� - _ _ -d:-� ..zse�ei+-..s_ . ; . .., ' - — �.:� ,}�;�,t. ...... . c..tsa.;, � , :a:,; CITY OR ERIDiEY � WA'TER. ANO SEWER CONN�CTlON P�RMIT APPLlCATI�N . I�rne: r,.�:� .�� �,Z zti�:; Date: �u� � ,�)9 �4 (tioaM +�+iw+�r o. �lumb..) LEGAL CE&CRIPTION K PERM�T: ` 9EWEA: WATER: :� FEE: FEE • 15 . �� O-0APTEfI: BTATE 8TATE .5ti SU RCHA RflE : 8U RCHA R(iE : TOTAI: TO7A�: 15.SQ GRAND TOTAL: �S' �� 0 METER: �' OE►OBIT: h0. GO TOTAL: ��•�Q S.A.C. CHAflGE QN EXISTING STRUCTURE: , EIQiST11ieG S�RUCTURE: NEW STRUCTURE: �11t131NG P�AMfT No.: SEWER ATER PERMI �� �„ , �ClAI /R�fS�irTS: SipMd• ` � • ��`' ey: