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EXHIBIT A <br /> Supplemental Data Sheet <br /> PERMIT NO. <br /> Community Date <br /> Individual Making Application Phoned <br /> Representing Who <br /> Location of Connection—_'36-40--5 <br /> Work to be Done by <br /> Type of Connection Depth <br /> Size of Connecting Sewer, P\1 Pipe Materia-i' <br /> Invert Elevation <br /> Area Served in Acres: <br /> Residential Commercial <br /> Industrial <br /> Predicted- F ow in Gallons Per day <br /> Initial <br /> Design__ <br /> lio <br /> Characteristics of Discharge: <br /> Residential <br /> Commercial <br /> Industrial <br /> Unusual Characteristics of Above (Strength, Oils, Chemicals , <br /> Temperature & etc. ) <br /> Page 3 of 3 <br />