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�EPAkiMENT OF LOMN,l;N1T1' DEYELOPMENT SERYICES <br /> � BUILDING PERMIT INFORMATION <br /> ����, / �`� �,� ,� , , <br /> /1DDRESS ,t- C1 � �2E� TYPE-- C�-!� =._iC'r.L= c-�-> �`� L2i <br /> (1) BUILDINC PERMIT FEE I � <br /> �' S <br /> (A) PLAN CHECK FEE ' <br /> 12) PLUMBINC <br /> (3) MECHANICAL 1 <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDINC PERMIT ISSUANCE <br /> (A) TO BE DETERMINED f>Y PLDG INSPECTOR INCH <br /> (BJ EXIST. __ WATER SERVICE, APPLICATION NO. <br /> (C) APPROX. LOCATION <br /> CHART <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDINC PERMIT IS- <br /> SUANCE FEET DRIVEWAY(TYPE) S <br /> E <br /> (7) STATUS OF SEWER CHARGES: <br /> BOND DISTRICT FOOTAGE _ <br /> N, �, E, W <br /> NOTES <br /> SEWER CONNECTION CHARGES <br /> YEAR TRUNK 5 <br /> LATERAL <br /> TOTAL CONNECTION CHARCES 5 <br /> SEWER P�PMIT FEE � <br /> CATCH BASIN PERMIT FEE <br /> TOTAL SEWER PERMIT FEES S <br /> (7) MONTHLY SEWER CHARCES: <br /> SEWER CUNSTRUCTION TRUCK S <br /> LATERAL <br /> SEWER SERVICE <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br /> CHART <br />� INFO COMPILED 8Y: DATE <br /> APPROVAL: DATE <br /> 9 1-79 <br /> J <br />