Laserfiche WebLink
• (ATTACH BLOCK FORM) <br />f~- ..- <br />`t <br />UTILITY VERIFICATION <br />• DATE ~~ /J ~Q <br />LEGAL DESCRIPTION: <br />STREET ADDRESS: <br />OWNER/CONTRACTOR <br />WATER <br />~e_ <br />• <br />~,6 ~ 'f <br />SIZE OF MAIN: <br />LOCATION OF WATER MAIN: STREET EASEMENT <br />ESTIMATED COST: <br />FLOW: <br />,ALLEY <br />SEWER: <br />CATION OF SEWER MAIN: STREET EASEMENT ,ALLEY <br />DIAMETER OF LINE: (Q „ <br />APPROXIMATE ELEVATION OF SEWER MAtN: 4,' <br />DISTANCE FROM EXISTING MANHOLE TO PROPOSID BUILDING ~ S~ ~ <br />SEWER TAP TO BE MADE BY: CITY CONTRACTOR <br />ESTIMATED COST: <br />COMMENTS : c~Q.C~~ j~.~,0 ca~iecv~ J~D " ~ S ~ ~ .~~'~ , N~ Pi~/~i~~~'wy1 <br />~~ 'r - <br />--o <br />SIGNATURE __ <br />• ~ DATE LD-~Z - d <br /> <br /> <br />