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' ENGINEERTNG DEPARTMENT <br />'_' Y3UILDING PERMIT INFORMATION <br />ADDRESS _ o� i /�/ r e�� �v%c"� �"i4/IQ�X /� 1 PE +� Ff'�. <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />2) WATER SERVICE TO BE PAID BEFORE AUILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETERMINED BY PLEG. INSP. �_ INCh <br />(B) EXIST.=��_ WATER S&FVZCE� APPL. NO. l,�i � _,r, <br />(C) APPROX. LOCATION 3L' _; ��' y(', �L e{ L o� _/� a7� 07�' <br />�° �d.C, — 9� 5� �` o �a,'��ox f;V � CHART .,�i 3'� <br />3) D:'2I�E�9AY PERMIT TO BE PAID BEFORE BUILDING <br />PP.ti�lIT IS ISSUED � FT. � D/W (TYPE) <br />Z�o�rrw* <br />4) 5::,:GS OF SEWER CHARGES: <br />IIO::J Z DZSTRZCT !? F44TAGF ---- <br />N, S� E, W. <br />.� SFwer Cha���� �2�. Go <br />�(r5 itvr �i �9G� A• 4� <br />q p �. d� 3 2 ZU �- <br />N <br />/�GsJ` �we � <br />I�i-cc_T � � 7 30� OZ� <br />� Cwa s 5 ya/ l...��.6u�aL � <br />�5j ::_..:.._'i SEIti'ER CHARGES: <br />SEWER CONSTRUCTION: <br />SEWER SERVICE: <br />;,np^��•;, :_��aTION OF <br />.�rs_,_ af � ei•, 60�� <br />�E._._So' er ' ra <br />I?:FJ �...=.?;,ED BY: <br />RE'lIE��: <br />APPB�`:',_.: <br />• /29, 00 <br />5 G2. 00 <br />$ <br />s ; z, o0 <br />S i48,00 <br />l!SEWER CONNECTION CHARGES: <br />YEAR '7G TRUNK S <br />LATERAL ��$ <br />TOlAL CONNECTION C2iARGE $ <br />�� <br />m <br />__.---- <br />SEWEit PERMIT FEE �—_�_— ' �'`�'" <br />ICATCH BASIN PERMIT FEE $ —� — <br />I �� � <br />� TOTAL SEWER PERP;IT FEES _ <br />TRIINK <br />LATERAL <br />SEWER OR TEE IN THE MAIN: <br />F'.,:��,�,v ,O�,rs _ 7 � neen <br />PROJECTS DIVISION <br />�^���DEPARTMENT <br />$ b� 20 <br />$ 2.../U <br />� �o � � <br />. i .. _f� .,n ., _ �t. <br />r,� -� - �n -�. <br />llATE 3-2�'7G <br />DATE <br />DATE -� ��'� �� <br />