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ENGINEERING DEPARTMENT
<br />BUILDING PERMIT INr^QRMpTION
<br />1�DDRESS -, -
<br />---� �- ° �-- �� ,� _ j? ' -•
<br />1) DUILDING PERMIT FEE \ � °' � " �
<br />(A) PLAN CHECK FEE =�''
<br />.'.) WATGR SERVICL•' PO DE PAID BEFORE BUILDING
<br />P�RNI'I IS ISSUED
<br />(A) TO DE DETERMINED IIy pLgG, Y�SP .{,�
<br />' 4 INCH
<br />(D) EXL';T._` WATER SER\%ICE, APPL. PIO.
<br />TYFr•, -
<br />.�_�' �`____ , n�-
<br />$ � -; j ,•; .,
<br />s—` G =_-`��--
<br />c
<br />� 2 00, n
<br />' ---_11--
<br />.�' , . ; , ,
<br />(C) APPROX. -��--"
<br />LOCATION i,, � G' .,. i � t
<br />. �r F ' 'Ss.✓Fr�� �
<br />� C, /. ,��, 1 . _�1_z__.
<br />3) DRIVEWAY pLRMIT Tp BE PAID BEFORE BUILDING CHART =���_
<br />PERMIT IS ISSUF,G �
<br />FT. _�__ p/W (TYPE)
<br />,�?'S F-T C:v,t,�c_{Z.
<br />9) STATUS OF SEWER �NARGES: i'OTAL*
<br />DOND _ DISTRICT
<br />_ FOOTAGE s-n � IU
<br />N, S, E W,
<br />Pa�f a�uG srw�rr cn�;t.-,.�;�,'��
<br />cha�•90 �d is�i.4s �/�R2Ct(_,�B)
<br />( R. hY �M..�I w;ry�
<br />cc3o Aeo, �q��d�
<br />'} —1'7I f�t s7'�'�
<br />�j - Chs . "1_�-.. q p �
<br />SL{9ER CNARGES:
<br />SEIJER CONSTRUCTION:
<br />SE;9LR SERV7CG:
<br />APPROX. LOCATION OF SIDE SEWER Oi:
<br />f ., .
<br />IiJPO COMPII,ED By;
<br />$_�� 50
<br />S :' � � . �,,,
<br />ISEWER CONNECTIOy CHARGES:
<br />YEAB ' 7 L TRUNK � � S- ---� � �_
<br />J, � /`� $ ° ] , rr,
<br />TOTAL COI4N�C�T���
<br />GE $_ 4 C 2. c-a
<br />SEWER PF.RMIT FEE
<br />CATCH DASIN PERMIT FSF,�f�
<br />:'OTAL SEWEk PERMIT F;ES
<br />TRUNK
<br />LATERAL
<br />IN THE MAIN: F „
<br />i�rvirw: • --
<br />PROJECT pI1jIgI0N --
<br />APPR�VAL: �
<br />�--_��� �
<br />ENGINEERING DEPARTMEN7' -----
<br />S 3,� , o0
<br />$ �j _
<br />S � �` _
<br />$ o, zc
<br />-----�..�a.l�'_
<br />2•id
<br />S �,
<br />$ �`f�Pfc-/'�d
<br />�-----_ ----
<br />._ , i. ,
<br />.—[c-:� pe r� • . — . ._
<br />i_- C- - 1�,.: ---
<br />DATE 5 '17 ,/� ----
<br />OATE
<br />llATE �
<br />� 1 ��-------
<br />* 1'his total must be I,�i� before building permit is issue,],
<br />
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