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EDIGINEERINC DEPARTMENT <br />' HUILDING PiAMIT INFOW�WTION <br />l _.. <br />ADDRESS - • �.- �r.. <br />.. , <br />! C,i .I �`-'�/`r-i r':r ;' . TYPE <br />1) BUILDING PERMIT FEE �( �-� r`71 •<< <br />(A) PLAN CHECK FEE <br />2) WATER SERVICE TO BE PAID BEFORE DUILDING <br />PERMIT IS ISSUED <br />(A) TO BE <br />BY YLBG. INSP. �� - <br />S ii'1. ��� <br />s -. �— <br />$ ._�-�2�. � r' <br />_ � c � <br />INCH ���� /J� � � <br />l� P�c., %L''; r'U <br />(L) F.XIST. WATER SERVICE� APPL. N0. <br />.i . �; i i <br />(C} APPROX. LGCATION �_C_% • .= >_. � <br />Y�L E=C�� �T��c;'_-;' � ` CHART /yY- %��=' <br />3) ilR.�'e:iAY PEEtMIT TO BE PAID BEFORE BU7.LDING <br />PEI2.�1IT IS ISSL`ED ��'=� FT. %�-�J�?'`,� D%W (TYPE) <br />TOTAL• <br />4) STATUS OF SEWER CHARGES: <br />BOSU�_ DISTRICT _ i,� FOOTAGE ` <br />N, S, E, W. <br />�; '�7— 137—C•C: <br />i ) ': .... ..'i SE <br />SEWER CONSTRUCTTON: <br />SEWER SERVICE: <br />APPlc?=>:. ' - ATION <br />Gr'_-%�C�� G/U <br />ZNI'0 C��?1PILED DY: <br />RE'; I E:� : <br />SEWF.R <br />SEWER CONNECTION CHARGES: <br />YEAR �_ TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGE <br />SBWER PERMIT f'EE <br />CATCH BASIN PERMIT FEE <br />,�� <br />S �.. .:�G; <br />S ��'`'�� <br />�/n.SU <br />5 , ',;�`�� . f.-;, i'�� <br />S <br />S ,�95:00 <br />$ .�f� • Ci�� <br />$ � <br />TOTAL SEWER PERl�iIT FEES $ .�O• �( � <br />i <br />TRUNK $ /'�� <br />LATERAL S � <br />$ �•�,✓� <br />TEE IN �FfE MI,IN: _ �,� � 5 • <br />CHAR'i' � :—Gl—� <br />t ! r'�—�- DATE < </i" i % <br />DAT.w'. <br />PROJECTS DIVISiON <br />APFR '.. .,. i.____��=s�1—� DA2'E � /cS' ��� -- <br />-' ENGINGE NG DEFARTMENT <br />