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= Fee 5.... r b_�.�_....... " `" � <br />VIf.LAGE QF ROSEVILLE N. 4454 <br />PERMIT FQR SEWER SERVICE CONNECTION N� <br />�' I� zq�.G�----... <br />D.t�.-------�. ... <br />° LEGAL DESCRIPTIQN . . . .. . . . . .. . . . .L--.A.� E'". . .� w..4S5o � 1 �- L �4 <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . : .. . . . �:-� T.S. . . . . . . . . . ��'� <br />�- o � t d <br />OWNER.t-�_��� :.�{..��;r.�.�?-,�`? ....:.. ADDRESS...�.� S S. C�waS�a �/��-1 <br />.... . <br />�,� c �- � � n <br />CONTRACTOR. . . . . . . . . . � `����. . . . . . . . . . . ADDRESS . . : . . . .. . . : . . . . . . : . . . . . . : . . fi �.e�` ! (s <br />! ���,L'L�' � <br />Aetion on applieations . N. �..r .. J�J. o. ,'�'li 5 � La.f C.. f� H�+ � G�- l 0�7 ,) �.-�v 15 Gei n b� c�n cid Q. <br />...__' ----- �o� ,�, w�, c� � c� �.ih 1 r h�. � 5 <br />WYE L�CATION -(Distance from nearest downstream manholej� ...- t-� �Q.t�S�,� .,�.y. . U. ! r l.c�. y Q, <br />`�-� v+ 3, 5 Z s s � M,� y� <br />ITEM APPRO ED DATE REMARKS - MATERIAL USED <br />JJye Connection into Sewer Main �Z% o �'`�'� � s i <br />� <br />Service Connection (outside Bldg.) �� -B -���� <br />Service Connection {within Bidg.) �"3-'�c_ ' �• �� 1' �"' <br />Reuse of Existing Sewer Service (1f applicable ) <br />�..�reet Resurfacing (if applicable) <br />Filling in of Septic Tank <br />�:i���f�sspooi %��i �t I V �� c= �u �= Y`�>E t� �'. � %�' �� <br />-------__ <br />.,��. ���.. <br />Sketch Information on Well for Seroice Charge <br />N. Arrow Well Size . . . . : . : . � . . . . . . . . . . . in. <br />Streei Ff Property Line ' Well Depth . . . . . . . � / U. . . . . . : . ft. <br />` Ties .�- <br />� / <br />%�� ` � Static Water Level . . . . .��. :? . . . . . . . ft. <br />�i.o: -�ri� � <br />� 1Vlake of Pump . . � 4� +.t-�:� �.k� .--iM a �s e <br />Model Number S. K.�. � 5!.E. .%. Z.,� jC <br />_:...�_.�_ Serial Number . . . . . :. . <br />� r.�—'--•—._. TYpe of Pump . . . . . . . . . . . . <br />� . . . . . . ��1.�.�f ' . . . . . . ' . <br />I � /f : , Motor H. P. . . . . . . . . . . . � . . . . . . . . . . <br />% f � /�j C� / <br />Jy � Addn'I Info . . . . . . . . . . . . . . . . . . . . . <br />r� <br />, <br />j _ � <br />���,o,�j� - RATED PUIVIP CAPACITY /a/ 40 p.�.i. �. GP1VI <br />� �-- <br />� �''`'s �' SIZE OF WRTER lyETER (if no well) <br />, <br />.. J <br />� /....................... <br />I � <br />Issued B �._1.,:..1,� . . ��� <br />y...•--•• - --------� -----... Ser�� rcorded: . . . . . . . . . . . . . . . . ' . ° <br />� . � � � . ��6 . . . . . . . <br />