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, l3UII,AING P�RMIT INI'ORMATTON <br />ADDRESS .✓ `f'�� � ��.i ..�'—/V7 G�. � Y �� <br />TYPE OF BUILDINC; �. _._/Q, _..,__ <br />—7-- <br />1) P,IiII.DING P]�RMIT I'�I: �S�`��' <br />(A) PLAN CII�Cl{ F�� <br />2) 1'�i,1'I:R SLRVICI: Z'O 131: ]',`.Il.) IiT:T'ORE BUILllJNG <br />PERb111' I5 1SSUrll <br />i::) T'O ];1: DLTL12n�SIIQl•;D ]lY P.LI3G. INSP, �� INCI-I <br />!! <br />DAT� G�^'�-7!i <br />$ ��Z• Oc� <br />�,� `� <br />!�) raIST. 14'AT�R SERVICE, AF: L. NO. _ <br />(C) LOCATION ���. %. �r � � �. O�' � ` <br />P �+�=F��-!���tYL%� CHART S.. � � �� <br />3) DRIV�IVAY PER:•�IIT TO IIE PAID �I:FORE BUII.11I1G <br />PER\1iT IS ISuQL•:D r--� T. r.----�- D/�V (TYPE) % $�' ��" <br />TOTAL�` $ �CO�/� <br />4) ST:'1TU5 OF SF.\VER CI-IARGES: <br />EOND `�—' DISTRIGT r— . FOOTAGE iZs�•� <br />N, S, E, W. <br />SE\1'�R CONNECTIC\ CH.4RGES: <br />TRU:IK <br />LATERAL <br />TOTAL CONtiT'CTION Cii�RGE <br />S�«'�R PER�4IT F�E <br />CATCH BASIN PER\fIT FEE <br />TOTAL SE�1'ER PERI4IT FEES <br />5) \f0\THLY SE\VER CH.SRGES: <br />SEWER CONSTRUCTION: <br />[��:iil.�:� <br />LATERAL <br />SENER SERVIC�: <br />//�pf�xLOCATION OF SIDE SE\VER OR TEE IN•THE MAIN: CHART G- - <br />v-� � ��,�. .� G�•N7'�, Q.�C i�,GA> �.9�L �72. � � .'t-� . <br />INFC C <br />R�\'IE\V <br />APPROVAL: <br />�D Y <br />�III�G <br />3� fi,�`� �. / ' �; <br />��'Thi: total must hc paid bcforc building permit is iosucd. <br />$ �_ <br />S <br />S �, t?U <br />S -�"'_ <br />� �O. a0 <br />5 _""' <br />5 <br />� 2. 5'O <br />�-. L�'.J- .7 <br />� ,y'i�tl <br />DATE �' "' ".; <br />DATE <br />_ DATE /// <br />