Laserfiche WebLink
IiUILllI'�G PEi:\tI'1 I\I'CR`.fAT10N <br /> :1DDRESS ` � , <br /> T1'PE OF AUILDING DATE ' <br /> � —��> , <br /> I1 13GiI.DIti'G PERRSIT FEE g / _' _- � <br /> (A) PLAN GHECK F�E 5 � - <br /> 2� t1';+TER SERVICE 'I'U BE PAID IIEFORE EiL1ILDI:QG <br /> YER\fIT IS ISSUELI $ �: �' l ,r" � / <br /> (A) TO BE DETER\4INED B1' PLf3��. INSP, IVCH <br /> // <br /> (�) E:CIST. �VA'I'ER SER\'ICE, APPL, NO. <br /> (C� LCCATION '� i ,1 , ,': � I' <br /> j2 N � , <br /> i � � ��;� l �Nr� c�cat�T s �:`�� <br /> � I DRIC`.R'AY PER\fIT TO IIE PAID IIEI'OR� liCILDI`:G <br /> PER\lIT IS ISS�JED �� �= FT. /,' ', '�, _,! ' � D/�C (TY1'L) S <br /> ` ; . . <br /> � TCTAL ' � ' � � � <br /> 4j STA'IUS OF�' SE�CER CIIAI2GF�': <br /> F�O\D�_ DISTRICT _ZS FOOTA, ;E: <br /> ' 1 � ,•, -�,�. (�; N, S� E, 11'. <br /> J <br /> L.�:CDSC.-�YE VOTES r SG�\"I:R CO'�:�ECTIO:�' CFLARGES: . <br /> -- TRUNK S �/J� )C) - <br /> LATERAL S ?,F i� J 0 i <br /> TOTAL CONNECTION CHARGE S L/,; .' •a � <br /> SE\VER PERMIT FEE $ _'J. _� J � <br /> CA'tCFI BASIY PFR\tIT FEE $ <br /> TOTAL SE�S'ER PERb1IT FEES 3 •��� %� � <br /> 5) ti1C:VTHLl' SR�VF:R GFIARGES: � , <br /> SE�1'ER CONSTRUCTION; <br /> TRUNK $ /•/,; ' <br /> LATERAL $ ' L ; <br /> SEWER SERVICE: $ ��- ' - <br /> LOCATIO?1 OF SIDE SEWER OR TEE IN TH� MAIN: CI-IART -j- /- , � <br /> �� f� �_ ! '/ 1 ' c � : : o //. _J - : <br /> i . <br /> E'�:I _7 i � �� �j. � �_ (� <br /> INFO CO�iPILED BY: ._�j�, � _ DATE_ <br /> REVIEW: � "�./� '� __— DATE � � �'_i <br /> ' 2AFFIC DIVISiON <br /> APPROVAL: Lt� DATE B'�Z�7j� <br /> GINI�ERlNG DEPA1fTMLNT <br /> This total nmst be paid br(ore building permit is issucd. <br />