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CITY OF LSA►PORTE <br /> INDYJrSMAL DISTRICF—WATER&BE ER APPLYCATION <br /> (LOCATION OUTSIDE OF MY LBUTS) <br /> HUSIN NAM: <br /> CONTACrPERSON: <br /> SERVICE ADDAM: M-ekA_") 1� "DC, <br /> C <br /> (ADDRw OP SITR REcEi a Acru.AL ii1 viM <br /> AMU. G ADDIWM: W!�C> t-A ic w k)CS-� 'D 9,.r <br /> (Al)DRRSS TO BE USED POR DILLU40) <br /> j 1 7k j _T..�L;s - <br /> N!)7'ETOCAN'APPROPRIITEBACKPLOWPRRV 'ION'1)BV1'CS <br /> ISRKQUJAW ON'TIM COMMIR'SSIDB OF TIM M13TAK AT T1IEPROPERTY <br /> LNF, FOLLOWINGCHYAPPROVA4 THE CERUIFM7TONTBS AVORT ON <br /> TILEDEYICE SN'XI,L BL PROYIDED TO TD'L C17rSPUBLTC WQA0DIVMQN. <br /> PTAFF USE ONLY <br /> Legal Descxtption: <br /> HCAD Parcel# <br /> H. <br /> All Admin.Fees Paid To Iuspection Services Divb1on: <br /> C.C.Approval-OWN Approval Date: <br /> Wator Service Use: Aomesdo Fire TndusWal Landscaping <br /> Sewer Service Use., -OR- NO <br /> CLT'Acceptance Of Water&I(k-Server Line(s): <br /> Confirm Landscape InstaIIation: <br /> Confirm Ba&fiow Protection Of City Main: <br /> Watu Motor Sime(a): Set Meter Only: Tap&Meter. <br /> ([den*$lzpK604 <br /> size Of Sewer Lag Qf A icaia]e): <br /> WATM CHAROW:$ Date gfPgwnenr(s): <br /> SEWER CHAR0139: $.... �beelptNo.# <br /> Coinputer H"by; WF#As&fgtad: <br /> 3:lCP3he►oUnspcctivnsllt�AYJS�RIAL W&S"PUCATION.doo 03-06.01�tev. <br /> r <br />