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. <br /> � � <br /> � L ARTMENT OF COMMUNITY DEVELOIM_.�T SERVICES <br /> BUILDING PERMIT INFORMATION <br /> ADDRESS � �Dl GOf�� �sJ� TYPE � •�� <br /> (1) BUILDING PERMIT FEE LQD��• �v 5 ���'''�� <br /> (A) PL�N CHECK FEE �� Q'�� <br /> (2) PLUMBINC rt ''L -B"v <br /> (3) MECHANICAL �S' � <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERM�T ISSUANCE ��/��_ <br /> (A) TO BE DETERMINED BY BLDC INSPECTOR s ¢ INCH <br /> (B) EXIST. WATER SERVICE, APPLICATION NO. <br /> (C) APPROX. LOCATION ��� �'� "r`�r^D.v /�/J�/� <n� <br /> ,4�9°iZm�x ¢5' E eF � E� �_cc,rs¢ �� <br /> CHART ���� <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR 10 BUII.DINC PERMIT IS- <br /> SUANCE ��F��'�=Y FEET DRIVEWAY(TYPE) 5 �� <br /> 3 <br /> (7) STATUS OF SEWER CHARGES: <br /> BOND DISTRICT FOOTACE �.�i7�lb�v� <br /> N, S, E, W <br /> NOTES ' <br /> � �,O �` CO Co 4- 8 G� <br /> ,C,�--e 1 <br /> �� 5�.ro� �. i.� <br /> d i�t/Jt l� Zi:� S MhY <br /> 178o AP � o�� L■,1+a►+�� <br /> PA�( A� , ' C�T1.�-tA� <br /> C�Q� .dU % SEWERCONNECTIONCHARCES <br /> �^'f""�=��''�' YEAR TRUNK b <br /> LATERAL <br /> TOTAL CONNECTION CHARCES S <br /> ���ql� , <br /> SEWER PERMIT FEE ((o� S ��' � <br /> CATCH BASIN PERMIT FEE ��/� <br /> TOTAL SEWER PERMIT FEES (//'� S �'�� <br /> (7) MONTHLY SEWER CHARGES: <br /> SEWER CONSTRUCTION TRUCK S —' <br /> �� <br /> LATERAL <br /> SEWER SERVICE 3• Sa <br /> APPROX. LOCATION OF SIDE $EWER OR TEE IN THE MAIN: ��� �T�' ""-' " • w � <br /> �p...v1�o��J � D� k.v � � TE�' � � - CHART N-/'Z 7 <br /> !,�� �i o� N�•�c�. ,. 4r�i�¢e�+c 5"otbr S— /$- 29 - S <br /> INFO COMPILED 8Y: DATE <br /> APPROVAL: DATE <br /> ¢1-79 <br />