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33UILDING Pi'Ct?�-tIT I\'FOR\fA1'ION <br /> 7<fit� <br /> ADUREss �,l�¢7�► � '� i ' �' , ��-��✓ ��:�, � — • <br /> TYPE OF IIUILDiIIG � :_._._� _ DATE - � !� � <br /> 1) BUILDING PERMIT ;'EE $ _ <br /> (A) PLAN CH:'CIr ;^EE $ <br /> 2) �VATER SER� IC > "O BE PAi:D REFORE IIUILDING � <br /> PERMIT IS IS5C E;� 5 , -• �i � <br /> (A) TO BE DETEi�;v1INED 3Y PLIIG. INSP. � INCH <br /> !/ <br /> (II) EXIST. �YAT�i2 SERVICE, APPL. NO. <br /> (C) LOCATION � i � <br /> /7"% i � ��. , � �: CHART <br /> 3) DRIVL'.VAY FLRMIT 'TO BE PAID L�FORI: DUILDING <br /> PER\4IT IS ISS�7ED I'T. - ' D/\1' ('^YPL:) $ • <br /> ' TOTAL � $? ' �' <br /> � <br /> 4) STATUS OF SE�1'ER CI-IARGES• <br /> BOND ., DISTRICT f FOOTAGE <br /> - r - ---5, E, W. <br /> LAi:DSCAPE NOTFS SENER CONNECT?ON CHARG�S: <br /> TPUNI{ ^y � � <br /> LATEI:AL $ � � � <br /> TOTAL GONNECTIOK CHARGE $ '! � <br /> SEIVER PERMIT FEE $ � <br /> CATCH IIASIN PERVIIT r EE $ <br /> TOTAL SEWER PERMIT FEES $ <br /> 5) MONTI�LY SE�YER CHARC;FS: . <br /> SEWER i.ONSTRUCTION: <br /> TRUNK $ � • � <br /> ' LATERAL $ <br /> SEWF.R SER`�'I::E: $ � <br /> LOCATION OF SIDE SI:�VER OR TEr IN THE MAIN: CHAf '.� �' �-, �.�-�, <br /> � — � ----- � — <br /> � � <br /> � , � , � • .• � /.!'�1:/L � .r " ,�� i C,�.v.. .�c�,�, � ', i <br /> INFO CCMPILED BY:���� _'�' g•� E �. - � � <br /> �/,- <br /> REVIEW• /, , ` . r� c:' : .� � � DATE /_%�%i'�7.y. <br /> TR�IC DIVISIUN <br /> �` / / �i 1 M <br /> AFPROVALs-- ,,,��� � D/+TE�_ Li - � <br /> C�- <br /> .� N INEERING DEYARTM�NT <br /> � This total must be paid befoi•e building permit is issued. , <br />