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� I3UILnING PERMIT INFORMA7'ION <br /> ADDRESS G�l;�� E� �r=��:n. U c' �r�/ <br /> TYP� OF BUILDINC,_ l'c-i=� c � y � T�,1 HGET -;-'r�.� _I)ATE C' ,': <br /> 1) BUILDING PF.RMIT FF.E /�'/C� C1��, �� S ¢ ?�, s'p <br /> (A) PLAN CH�CK FEE $ Z7� . L D <br /> 2) WATER SF_RVICE TO IIE PAID IIEFORE IIUILDING �.Y-, <br /> PE;RMIT IS ISSUED � �7��, — <br /> (A) TO E�E DETERMINED IIY PL.DG. INSP. � , INCH <br /> . ll <br /> (�3) EXISTZ' �/,� WATERSERVICE, ApPL. NO, �;�=� ' <br /> �C) LOCATION t� '�S' E _4n / ,- ' <br /> ..+,C p i � •C r�� !l�. � <br /> 7 , - � <br /> a `�° A r.,f . �..-i,�.',� AJ� o�- �l_G n CIiART -� - 2�?� <br /> 3) DRIVE�VAY PERMIT TO BE PAID 13�'?'ORE I�UILDING <br /> PERNIIT IS ISS:JED^-.:� ' FT. ���1C„ _D�W (TYPE) 5 <br /> TUTAL' y <br /> -1) STATUS OF SE\I'ER Cff.SRG�S; - <br /> 130ND_� DISTRICT ��_ FOOTAGE � <br /> ��, �t'. <br /> I.A\1)SCAPIs NOTE:; SEWER CONNLCTION CEiARGF.S: <br /> TRUNK S_72?. 8/ <br /> �I'F ttAL 4 �j'f7 � -- <br /> / 7 `J ( <br /> TOTAL CO�P3�CTI�N` /G�ARGE 5_ �(� D�• �p/ <br /> SEWER PERMIT FEE � <br /> CATCH BASIN PERMIT I'EG 5_6 <br /> TOTAL SEWER PERMIT 1•'EES $ _g ' � <br /> 5) \1C�iTIILY SENER C}IARGES: <br /> SEWER COA'STRUCT ON: <br /> 17�1fN0 '�j L7� ��� lf TRUNI{ 5 �2 •9�_ <br /> !�� 5�...- � •o.��- •,s••.��•r� LA T E RA L 3 O 2- <br /> _/!o• <br /> c�-,..s,fP�, ..c.�. s-ss. o!G-s. / ;-2,r�oa-ao <br /> 1 SE�VER SER\'IC�; ¢� ���� <br /> Z LOCA'I�IOiVt,OF SIDE SEWEI�OR TEE IN TIiE MAIN: CIiART :�- '�- , .� _ .� <br /> �p �, �or � `,� wr �: • ,; r �. � _• „ .. „ y � -- . <br /> I- � / ' ' 1 i � ..Z�.. �-'1 G�� � �.r{ '� <br /> �� L ' 2if� ' <br /> � F ��T � � �rr. � <br /> y �NFO C0�1PILED BY: .�.,,,� ,� .�+�. _l _! r _ DATI: I�" /%-�� <br /> :•S. RE�'IE\Y: 7�� DATE: ��/ ? � _ <br /> "� T FFI D VISIO`N�v ���,� ��,p � <br /> f�17 � � / <br /> I"�� AII'FI�`O�A-L. l���� DATE���J <br /> S 'GI .RIN(; DliPARTMENT <br /> ����� <br /> 7'his total must be paid before building permit ie ieaued. <br />