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BUILDING PERMIT INFORMATION <br /> ��� <br /> �� � ADDRCSS _TYPL . <br /> S _ �1 / `l SYl <br /> Q y ;1) BUIIDING PERh117 FEE ___ <br /> ��� (A1 PLAN CHfCI. F[E =_ <br /> � (2) PI.Uh1fiING <br /> ���v (3) M[CHANICAL _ <br /> y, (4) 1ti'ATER SFRVICt TO DE PAID PRIOR TO f3UILDING Pf ��jT�SSU INCH ��� <br /> ��.Qj. � (A� TO FIE DtiTFRMINED BY RLDG INSPFCTUR _ <br /> �� g ([l� FXIST _-- WATfR SERVICE, APPLICATION NO _ <br /> �` � �(') APPR('iX LOCATION . — -- <br /> H <br /> � yH _C'iART • -- <br /> g�� (S) DRIVE�h'AY PFRMIT TO BC PAID PRIOR TO HUII.DING PFRMIT IS- • , <br /> FEFT DRIVEWAY (TYPE) S _— �� �E�' <br /> �: ; <br /> �a SUANCE _ — E <br /> ON - --' <br /> (7) STATUS (�F S�FR CHARGfS _f0(�TAGf <br /> HI�ND _— � [�ISTRICT _ <br /> N, 5, E, �N <br /> NOTES <br /> C rc� l l >1-�s S'� �ti /d�. sd <br /> �„�a�lei l79 <br /> ,-. S Pu/�/ �171 <br /> ���' G50 <br /> 1 � <br /> , � `� SEWER CONNECTION CHARGES `/� ��, <br /> Y'EAR �----TRUNK b _ <br /> LATERf�I. oc <br /> I �� TOTAL CONNECTION ChIARGES s --T��--- <br /> 7^ r <br /> S �, � - <br /> � (_' SEWER PERMIT FEE _ <br /> CATCH f3A51N PERMIT FE[ 3P � <br /> TOTAL SEWER PERMIT FEES S — <br /> � ' ,w� (71 ��1pNTHLY SEWER CHAFGES: <br /> SEWER CONS7RUCTION TRUCK s �—'—'"— <br /> � LATERAL ---- — <br /> I � <br /> i � SE\NER SERVICE <br /> \ <br /> APPRbX LOCATION OF SIDE SEWER OR TEE IN THE MAIN, <br /> — CHART _. <br /> INFO C0�IPILED f3Y DA1 E <br /> DATE — <br /> APPROVAL — — <br /> 1.,,. <br /> :�=' <br />