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DISCLAIMER FOR CONNECTING TO EXISTING SERVICE I UNDERSTANAD THAT WHEN CONNECTING TO AN EXISTING SERVICE, I, THE OWNER OF THE PROPERTY, AM SOLELY RESPONSIBLE FOR THE 4 SERVICE LINE CONNECTING TO THE DISTRICT S SYSTEM SHOULD FUTURE MAINTENANCE AND/.OR DEVELOPMENT BE REQUIRED. FOR OFFICE USE ONLY FEES PAID: SECURITY DEPOSIT: CAPACITY FEE: IMPACT FEE: PERMIT NUMBER & DATE: SPECIFICATIONS: INS.

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