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ENGINEER3NC DEP�RTNENT <br /> � BUILDING PERM:T YNFO.^,.MATI�N <br /> ADDAF.SS �?. i ti_ � :. /. � r- ,� �, „ TYPE S f� /i <br /> 1) G!iIif)SNG PERMIT FEE S D <br /> f1+) PLAN CHECK FEE � <br /> 1) h'ATER SERVICE TO BE PAID BEFORE BUILDING <br /> PERMIT IS ZSSUED s _ . <br /> � <br /> (�) TO 13E DETERMINED S� PLSG. SNSP. 3/q INCH I <br /> (B) �XIST.��� WATER SERVICE, APPL. N0. S,�r�0 <br /> i�.) APPHGX. LOCATION f3 ' S , n} n/. f�� e f / f- �9 i/ � G <br /> �.5. S. �I, <br /> -°tt_ W. ��a CHART -_s , <br /> 3) J::- ::.�iAY PERMIT TO BE PAID BEFORE BUILDING <br /> i::::<:'.' IS ISSUED — FT. — D/W (TYPE) $ <br /> Q � /26 T,�lal��� �■ ���-� , -� /�O OFi� ST P/4/!KlN6 —� <br /> � '�'9` 7D 13� �Rov� � oT�.• s /(v z . o0 <br /> 1 S`.".;i3 OF SEk'ER CHARGES: ��`�%/y <br /> _�� DISTRICT N . 4. FOOTACE /��� tc�p� <br /> N, S, E, W. <br /> ' NOTES SEWER C0.'JNECTION CHARGES: <br /> II YEAR ' 7G TRUNK $ <br /> I.ATERAL $ -- <br /> + TOTAL COYDJECTION CNARGE $ <br /> SEWER PERMIT FEE 5 3 O, o 0 <br /> CATCH BASIN PERMIT FEE $ --. <br /> TOTAL SEWER PERA:IT FEES 5_ 3 � , � �� <br /> , . �i:iiER CHARGES: — <br /> SEFER CONSTRUCTION: <br /> TRUNK $ — <br /> LATERAL $ -- <br /> SEWER SERVICE: $ ., 5 <br /> / <br /> '." . ",TIO� OF SIDE SEWER OR TEE IN THE MHIN: '�'S ' $ � ° f r� T`�„K. <br /> _l s 7"�c.�_ __ - ''''"• - � - � a <br /> �i:t_ (�� L .-_� � � C'n t «.i' K CHART L - 20- ZY -S <br /> . :_::� DY: ,:.�`, � ��� . � e:. . _ _ DATE _ , , <br /> � :'i � -Jc.. <br /> ;:� ,.. <br /> ' '' DATE <br /> � � � P JECTS DIVISION <br /> ADp.. ...� ' n*�nv � ��� <br /> /� <br />