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P - 74938�� fY7�� ` � ��-., S p c' > CITY OF FRIDLEY WATER AND SEWER�ONNECTION PERMIT�� yy�4y APPLICATI ON 5,�,�,�� .�.� Name: .aade Savage Date: ��2 3� 19 92 � (Home Owner or Plumber) Job Address: 567 Itice Creek Terrace NE L T NO. BLOCK TRACT OR ADDITION LEGAL DESCRIPTION �,13 2 Rice Creek Terr P1at 7 PERMIT:�-'r \� � SEWER: X FEE: 25.00 � O-DAPTER: ;'/ STATE ' .50 � SURCHARGE: �� TOTAL: 25.50 \. �_ _ -- _ -- S7� 0 . 0 WATEP_.�_,` METER: �"� .i .._ FEE�� .<.,.e� DE�IT: ' _ ' '9Q�u�fJ � ��/�/S � jT � ��.f,� � �, , � � -�41 STATE ��-��_ iCHARGE: TOTAL: SAQ Charge GRAND TOTAL: � ` .� / 4-� �'�`��f,� TOTAL: � �/.� �'� ' S.A.C. CHARGE ON EXISTING STRUCTURE: EXISTING STRUGTURE: NEW STRUCTURE: BUILDING PERMIT No.: SEWER/WATER PERMIT NO.:� �_ SPECIAL ASSESSMENTS:/��' °� � ---- Signed: Cl' L?E� i7�?� y % - � -� BY�