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ENGINEERING DEPARTMENT <br /> - BUILDING PERMIT INFORMATION <br /> ADDRESS �; O `i l�/. ��u s ;.� � � %i c� TYPE � �'i � , ,- c I� <br /> 1) BUILDING PERMIT FEE �� I� ' . _ r" � `� '- � � ;� �r � �.� <br /> (A) PIJ1N CNECK FEE '3-� '�/� 5 � ��' •s '- <br /> 2) WATER SERVICE TO BB PAID HEFORE BUILDING 5�v � -�� <br /> �+ 2 7 5'. o d <br /> P'cRMIT IS ISSUED r �' �+ <br /> � ( ,_ � , ['-� <br /> (A) TO BE DETERMINED BY PLBG. INSP. INCH <br /> (B) EXIST. WATER SERVICE� AFPL. N0. _ <br /> (C) APPROX. LOCATION �.{j �� /� ,C, M A f.0 •2`� � � � F � <br /> � C /��' 1 ) o �� CHART -2� S , <br /> 3) J3�':ihAY PERMIT TO BF PAID BEFORE BllZLDING <br /> P::R:�:I; IS ISSUEDz��� FT. � D/W (TYPE) 5__(7, O � <br /> TOTAL* $ �D�3• �� <br /> a) 5::�::;5 OF SEWER CHARGES: <br /> u:;:.J_�_ DISTRICT 3b FOOTAGE z g 8� � <br /> N, S, E, W. <br /> 3-��co - 29�` �\ <br /> i � NOTES SEWER CONNECT20N CHAAGES : <br /> YEAR i7G TRUNK +`'1���� 5 ?4D..I� <br /> �r. Q �nv� O -�Gr�fin' or•AQ ? <br /> a � t ..� - ��a..k ;..� A,-�v / r.�x�tuL 89Z ,b'o 5 �.hIU <br /> `' ���:'�2�' kd�� —�� <br /> � T NECT . CHARGE $ �� <br /> No : P-�k;�9 plan �/32.9b <br /> l,a.As c �r i n 9 SEFTER PERMIT FF.E 5 3 �, �D <br /> Cw �der �s �.nde� r�/J �lOet <br /> CATC;� BASIN PERMIT FEE S <br /> I TOTAL SEWER PERD;I'f FEES 5 <br /> a <br /> : S.:IiER CHARGES: <br /> SEWER CONSTRUCTION: <br /> I ��,t y �, TRUNK $,Cy S <br /> ����'' ILr LATERAL (U, (i%� $_ (o .�'L� <br /> SE��^�` FI� 7F��D <br /> R SEAVICE: $ a�P <br /> . ' . . �;,TIOy OF SIDE SEWER OR TEE IN THE MAIN: �� ' - � <br /> �_M, ,�f, � L w — � _ _ � - z � w G <br /> ,�1 I'1 � l � — , p � CHART W- i t - z - 9 <br /> D BY: �' n....-_ DATE � -7- L - J!o <br /> 4/]��A • <br /> _ .' ..... . � /.� 'I I DATE <br /> .� (;,or ��.r(r �.._ ,$Q.�E ��D�IVISION <br /> A�';' ' . �/ ,` <br /> DATE s/�/G <br /> " ENGINEERING DEPARTMENT , <br />