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4 <br /> DEPARIMENT UF COMMUNITY DEVELO�MENT SERVICES ' <br /> BUILDING PE:�MIT INFORMATIQN <br /> ADDRE�S ��`t ��-��-� �--Qu�= TYPE �� r '� <br /> (1) BUILDING PEQMIT FEE fi�3,0� `�`� 3 2`�i• S� _ <br /> (A) P�hN CHECK fEE 23 4U �/���c , <br /> (T) PLUMBING '����`� � <br /> (3) MECHANICAL _ �-'`` L'� <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE �6� . 00 <br /> (A) TO BE DETERMINED BY BLDC INSPECTOR � INCH �'��*• �`���"Y <br /> (B) EXIST. _,_ WATER SERVICE, APPLICATION NO. <br /> (C) APPROX. LOCATION �'�� � r• �N�� /�s'ne-vx /S� <br /> z <br /> u <br /> �.� • � <br /> � �-� `� � �'t'�'p �� CHART W- 21 lp m <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILD�NG PFRMIT I�- $ ,, ,, <br /> SUANCE �s FEET ����� DRIVEWAY(TYPE) S ` �'S� � � <br /> s C %� � N m <br /> 0 <br /> mo <br /> f7) STATUS OF SEWER CHARGES: � �c <br /> BONO � DISTRICT ___ FOOTAGE �� <br /> N, 5. E, W '^„ <br /> o : <br /> NOTES a .1 <br /> • rx <br /> __e"�`iW �c(u� � .--'�`� / �"� � N <br /> �/"✓ LC�O�'�CJ !� ' O .� <br /> �CU I �22 � , Oc� _ � <br /> �i�..eu�c� .�i.3a mv+ <br /> 0 <br /> or <br /> � c�m <br /> •� �� <br /> � <br /> z c� <br /> -�r <br /> • m <br /> a <br /> SEWER CONNECTION CHARGES 7O <br /> YEAR 83 TRUNK 3 <<� �� a <br /> z <br /> LATERhI — .� <br /> TOTAL CONNECTION CHARGES S � ��" �v I � ,_'"„ <br /> z <br /> . a <br /> -i <br /> SEWER PERMIT FEE � y 3 S '�` '�� � <br /> CATCH BASIN PERMIT FEE °� IB� — I• m <br /> TOTAL SEWER PERMIT FEES `�I�� S �- d� <br /> _ '� <br /> 7) MONTHLS' SEWER C�iARGES: � <br /> SEWER CONSTRUCTION TRUCK S _— <br /> LATERAL — � <br /> SEWER SERVICE -- <br /> \PPROX. LOCATIpN OF SIDE SEWER OR TEE IN THE MAIN: fl � MQr� � �� ���''�r <br /> :1L2_L6LZt—.n_.� T,'7 ��L� � <br /> CHART �- IZ�ZS-d <br /> NFO COMPILED BY: DATE <br /> �PPROVAL: _ DATE <br /> , �y <br />