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EXHIBIT A <br /> Supplemental Data Sheet <br /> PERMIT NO. <br /> Community Date ,� <br /> Individual Making Application Phoned Representing Who <br /> Who , <br /> Location of Connection D . <br /> Work to be Done by. <br /> Type of Connections�IId.�L Depth_ - <br /> Size of Connecting Sewer i,7 ��_ Py(-1 Pipe Materia xW-' <br /> Invert Elevation <br /> Area Served in Acres: <br /> Residential Commercial !� <br /> Industrial <br /> Predicted• F ow in Gallons Per day ht�� <br /> Initial © Design <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 />