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22 04 06: 35p prr. n Ledbetter 209-7:" '`.04 p- 1 <br /> I` <br /> I.00E FORD COWUNITY SERVICES DISTRICT <br /> P.O.BOX Z <br /> LOCKEFORD,CA 93237 <br /> (209)727_5035 FAX(289)727_5204 <br /> APPLfG4 TION FOX CONjVbMQN OF WATER 4ND/OR SEWER SFXk1C4r <br /> TODAY'S DATE oZ— f 3�O 74 <br /> APPLICANT NAME <br /> TO BSM � �A `per," LO/T�K <br /> APPLICANT'MAILING ADDR66S� <br /> TELEPIIONP/RESIDENCE%a `l���1� 11 —BUSINESS <br /> DA'M APPLICANT WILL HE READY FOR SPRVICEV V\N C �Aq t DATE OF MMPANCY <br /> UTILITY LOCATION ON PREMISES VERIFIED BY DISTRICT: T-b�_,� <br /> PURPOSE FOR WH"SERVRX IS TO BEUSEO. Uwtesse k� Cttemtates! EJ Other <br /> wHETHERAPPUCANTISPROPERTY: Oa,, `U Canaoaor El Developer <br /> 140-OF SINGLE SEWER SERVICE CONNECTIONS S 4200.00 PER UNIT-S Ir 4a 00. CR7 <br /> NO.OF SINGLE WATER SERVICE CONNECTIONS„® S 1,330.00 PER UNIT=S ash L 6r p. Ct7 <br /> NO.OF METERS QAS PFR UNIT=S <br /> TOTAL REQUIRED FEES <br /> TOTAL FEES RECEIVED S L1je76O•Q9 RECB/pFK--)@1E/v2y ✓ iOF , <br /> This appUcadon is your receipt of applicable uatu and aewm Cenrxctivn Chas"and is collected puraiant to Ordhaauce 94-1. <br /> Wales sndror sewtA srnice ctaa9v begin on date oroccopency.Pkaw ennead w ufrm when you are reedy to trsume s,,ke, <br /> Our Mr.hero.are 9:30 AM until 12:00 PM,Monday 1h ouch Friday. Tel"hooc Namhor(209)727-5075.Tble application is <br /> your receipt of payment of requited service connection fas. <br /> I ORDINANCE NO-79-1 SFCIION 5 WATER SERVICE RWUe ATIONS I <br /> I ORDINANCE .7 , 4SEW SSR REGU ATIONS j <br /> If work under a permit is nes c mmd wiain six b munlhs from the date of issuance of the permit, or if&flu partial <br /> completion the work bums disconripu or peri o a,the Pvmil Jaen themtpon become void void and no f Mber wwk <br /> shall be done"mail a new pcireit shah droll be aid upon the imams,of said naw permit. <br /> SIGNATURE of Applicant ' <br /> ••PAOPSAfyOaN <br /> SIGNATURE of Locktfotd Comfmaity Services Dat ici <br /> "GEMAAL MANAGER ORA077 R/ pAArva• <br />