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I"FC <br /> �i�Fv <br /> Sewer Water Hookup Form MAY q <br /> ?0 <br /> Date: <br /> Inspection Time: <br /> ANO <br /> Job Number: p /oU <br /> Builder/Homeowner Name: <br /> Site Addresss c.((o 5�7 vn ka ve�'uV L,w <br /> Footages Pipe Size <br /> Outside Waterline Pipe Bedding Materials: <br /> Inside Waterline Tons 3/4"Clear Rock <br /> Sot' 4"Pipe Footages Tons Sand <br /> Condition of Trench: <br /> Quantity Quantity Size <br /> 4" Sch 40 PVC 45'Ell 1"Flare to Flare Union <br /> j 4 Sch 40 PVC 160 Ell 1"Flare to Thread <br /> 4" Sch 40 PVC 90"Ell 1"Ball Valve <br /> 4"Sch 40-35 Adaptor Curb Stop Box (Size: <br /> 4"Sch 40 Cap <br /> Other U W Other <br /> Other Other <br /> As-built Dlawam <br /> p.,rostd WeA <br /> Ton g y,ew Mai h, <br /> n� <br /> Bohn Well DriNmq CD Paperwork Completed By �/ <br />