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CASHIER S VALIDATION
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SEWER PERMIT APPLICATION
APPLICANT TO FILL IN SHADED AREA
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ASSESSORS PARCEL NUMBER: f£?(f?~~ %? $0"" iPJQ
COMMENTS
SEWER PERMIT NUMBER SE 2.S& 3
BUILDING PLAN CHECK NUMBER PC ":~/6 * Y3O
. BUILDING TYPE - '•'•'}, J" lAL.
NUMBER OF EDU'S /' J
CALCULATIONS
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CONNECTION FEEJT , .. rf
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COST PER UNIT / >.V£/ x NO UNITS ' -O£^
LATERAL CHARGE
TOTAL CHARGES ' / OQ O
PREPARED BY :- i &*" / S'-' fj£
(PRINTED NAME)
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