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P - 75020
�i,�$+�,a a„�.:$�>+C^Il�d"F*'..'�:r:'"kx?: � .z +r. .,..+:Y�,T.,�r�^<�kt .r . ,;.:a-� <a wr _" j°� .�p;,;.._�,� ,�.yk..�._ ' 1A. • CITY bF FRIDLEY -. ����(O , -,._\ : 1/ �.,_ WATER AND SEWER CONNECTION PERMIT ����;` ��,,,Y APPLICATION �`�" ;/�L �S � Date: "� 19�.._ (Hom� Ovrn�r�Plumbsr) �. .�Ob 14��ASS: / LEGAL DESCRIPTION I�T No. ' I a�oCK f.. ;-fi�� i / I/ PERMIT: �+ ✓ SENIER: � WATER:�_ METER: FEE: � FEE: /°S" �� " OEPO6iT: ' O-DAPTER: STATE SURCHARGE: � SU ��E: � .a� s� `� TQTAL. TOTAL: TOTAL: � U1� GRAND TOTAL: S.A.C. CHARGE ON EXISTING STRUCTURE: EXISTING STRUCTURE: NEW STRUCTURE: BUILDING PERMIT No.: °Z SEWE6t�IF�jrTE�PER�� NO.: � SPECIALASSESS141EN� �1 Sianedr�•L.-✓�1�� u� ��✓�s