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ENGINEERING DEPARTMENT
<br /> - BUILDING PERMIT INFORMATION
<br /> ADDRESS_ G 7 ..� / ��' • !i' ,I TYPE , '- �,. ,,.,, 1 '
<br /> I) �UILDING PERMIT F'EE ' ` ' $ ''!�(�. k`�
<br /> (A) PLAN CHECK FEE $ � yy. �
<br /> . • -n
<br /> 2) WATER SERVICE TO BE PAID BEFORE BUILDING o � z "��nTn,,
<br /> PEAMIT IS ISSUED $ ^
<br /> /�f.'��. ��,i �_'
<br /> (A) TO BE DETERMINEL� BY PLBG. INSP. _ INCH Mg��
<br /> (D) EXIST. -- WATER SERVICE, APPL. N0. --- - •
<br /> ' (C) APPROX. LOCATION � �� '"�..f,.4 /ll�`c �l S�it' e �I4 i�
<br /> L I �
<br /> u G�C�� I (O UI (�_ �� (_ � CHART :. - � e�-.;,�
<br /> 3) Di::':::i';AY PERMIT TO BE PAID BEFORE B ILDING
<br /> PC:.:;i; IS ISSUED � FT. ,�Q� ,,l, D/W (TYPE) 5 / � .�,',
<br /> TOTAL' $
<br /> 4) 5:;,,;;5 OF SEPTER CHARGES: �'�
<br /> ii�::J_� DISTRICT � FOOTAGE �Ci � ���
<br /> N, S� E )
<br /> ?,- oz-- /5 "1- � /
<br /> NOTES SEWER CO:INECTION CHARGES:
<br /> YEAR � ;'(. TRUNK $ ;! , OC
<br /> � � r4 �R «'� B , ` LA E $ 93F'1. 30
<br /> / /�� i 7�J
<br /> /Vee d .�°0.Sew,c.�t -�;v Se�--e� TOTAL COS^r'EC'TI C RGE $ S'S,T, 3 D_
<br /> � + ��t2 � 7��U EJevc hte�._. (.l1 ' 1 ;.��. :•.,,.••� �
<br /> i�f�(ia'/!1�*-��FO�'' �LOCfii7� d SEWER PERMIT FEE, ' , ' ': :;':',,., $
<br /> ��v� '�'�� A��p CATCH BASIN PERMIT FEE�'��' '' $
<br /> , � /r
<br /> TOTAL SEh'ER PERA:IT FEES $
<br /> „ :: . : 5EttiER CHARGES: + � �
<br /> SEWER CONSTRUCTION:
<br /> TRUNK $ , 27
<br /> LATERAL S y ,S2
<br /> SEwER SERVICE: , S Me,`errnA
<br /> /v��
<br /> „?'�_'. �'•:. ". �:,TION OF SI�DE SEWER OR T�E ZN THE MAIN: {�'' ,�,', c� ��Jf! a f
<br /> S_Nr4rt.+ ' I t � � ;✓? /I�tn:f (�' �..� fr �f / , i
<br /> - CliART C - ; i'. F -.;'
<br /> I::_' .: : " ..:�D DY: I�4' �..' ��� DATE ;���; •: % :��
<br /> �1 p1'lb ,J � ,J.,
<br /> R}:':':::i: �_��ti � 1' �i1M� . �� C� 11A11� DATE
<br /> R J�CTS DIVISION
<br /> , —'_yL7�?�
<br /> APP°. ".'... : ii'I,l�y,.�� DATE f�
<br /> � ENGINEERIN(T, DEPARTMF.NT
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