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Name: <br />Address: <br />Phone: <br />FAX: <br />E-mail <br />Note: <br />V�NCE uJOaD . '/a ✓tGrc �E,�eix. <br />¢30 3 kussEc.� D.c, <br />pvyl7N, Tk 7k7a� <br />4fz 3z` 2`p7 <br />Snow 5i5f8 01 1r9 <br />Date: JAW R10 <br />Please include check for recording fee payable to "Hays County Clerk" for $14 + $2/page for legal description. <br />Plat Date: <br />W49 <br />Tax ID Number: _R ie Z40 C& <br />z <br />Proposed Use: %001wesidential NioCommercial [I Industrial 0 Other 40'M <br />Water Service Area (CCN)-. I NOT 110 <br />Service Requested: V*Wastewater* mater *Note: City wastewater service is available only for City water service customers. <br />Type of Request: connection to existing main 0 Extend existing main to subject property <br />Z <br />Estimated Utility Demand: AV % ?,V&41pw MA#� WW It a AVWFZ S024* <br />J <br />WAVF00 af ff <br />VOOO'Please attach calculations for average and peak flow conditions for each service requested. <br />W00*0 Please attach a map and a "metes and bounds" legal description (from deed or survey) of the property for which <br />service is requested. <br />If the property is not contiguous to the existing city limits, please attach the required requests for annexation along the <br />extension. (Not required for connection to existing main fronting the property to be served.) <br />See Owner's Acknowledgement and Consent to Annexation on the next page. <br />Form last updated: 10/26105 Page 1 of 2 of <br />EXHIBIT B <br />