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ENGINEERING DEPARTMENT <br />BUILDING PERMIT INFORMATION <br />ADDRESS 1 I �- �•{/ �/ _ _. ;'- TYPE <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />2) WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETERMINED BY PLBG. INSP. INCH <br />(B) EXIST. WATER SERVICE; APPL. NO. <br />(C) APPROX. LOCATION <br />CHART <br />3) DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED FT. D/W (TYPE) <br />TOTAL* <br />4) STATUS OF SEWER CHARGES: <br />BOND 111 DISTRICT FOOTAGE <br />S, E, W. <br />'EK CHARGES: <br />SEWER CONSTRUCTION: <br />SEWER SERVICE: <br />SEWER CONNECTION CHARGES: <br />YEAR 7 -7_ TRUNK <br />(-� �01ZTERAL <br />TOT L CON I0� CHARGE <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />TRUNK <br />LATERAL <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />CHART <br />INFO COMPILFD BY: <br />REVIEW: <br />PROJECTS DIVISIUN <br />APPROVAL: <br />ENGINEERING DEPARTMENT <br />DATE <br />DATE <br />DATE <br />S <br />$ 4i0. s 62i <br />S 57r. 9 s <br />S /059.¢4- <br />S 30. 00 <br />S <br />$ 50• CZJ <br />