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DE�ARTMENT OF COMMUNITY DEVELOPMENT SEltVICES <br /> � �Ts�: ` � BUILDING PERMIT IN �ORMATION <br /> � � � � ; <br /> ADDRESS TYPE <br /> _ (1) BUILDING PERMIT FEE $ <br /> (A) PLAN CHECK FEE <br /> (2) PLUMBING <br /> (3) MECHANICAL <br />► (4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br />' (A) TO BE DETERMINED 8Y BLDG INSPECTOR INCH <br /> (B) EXIST. WATER SERVICE, APPLICATION NO. <br /> i (C) APPROX. LOCATION <br /> CHART <br /> (5) DRIVEWAY PERMIT TO DE PAID PRIOR TO BUILDING PERMIT IS- <br /> SUANCE FEET DRIVEWAY(TYPE) $ <br /> 3 <br /> (7) STATUS OF SEWER CHARGES: <br /> f30ND DISTRICT FOOTAGE <br /> - N, $, E, W <br /> NOTES <br /> + : _. . <br /> . <br /> $ . � . <br /> „_... .,.._ . ....-. <br /> ' � ' . .._;;�,,.�.. 3,- _. <br /> F k <br /> � ��; , �� ,�.,� 7 � <br /> •�� r % �� ` �� . <br /> °i71 4 > }k 1 .»} i.... ..� _... <br /> .{�{ 1{ � <br /> u... ...V ➢ Y�.[ ��.. ` .. P.-.+. ..� _... <br /> .tir.:...n.. �� <br /> --w-w�-- SEWER CONNECTION CHARGES <br /> """'""� TRUNK S <br /> .„_ YEAR <br /> " LATERAL <br /> �- TOTAL CONNECTION CHARGES $ <br /> -;r.; <br /> SEWER PERMIT FEE $ <br /> CATCH BASIN PERMIT FEE <br /> TOTAL SEWER PERMIT FEES $ <br /> (7) Mi:NTHLY SEWER CHARGES: � <br /> SEWER CONSTRUCTION TRUCK <br /> LATERAL <br /> SEWER SERVICE <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br /> CHART � <br /> DATE I <br /> INFO COMPILED BY: , <br /> DATE <br /> APPROVAL: ;"� <br /> ;u <br /> ,j 4 ,��� <br /> >t���,, i <br /> ,, , ;� • " ,.: . <br /> I 91 79 �_ <br /> t. <br />