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<br />BUILDING PERMIT INFORMATION
<br />ADDRE55 �2�?+ �L�T/l�Nlf �JT TYPE�
<br />(1) BUILDING PERM�T FEE l�C��• � , S
<br />(A) PLAN CHECK FEE
<br />(2) PLUMBINC
<br />(3) MECHANICAL
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<br />(4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE �O�D� (� •��.j �
<br />(A) TO BE DETERMINED BY BLDG INSPECTOR INCH , ''' �
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<br />(B)' EXIST. ' WATER SERVICE, APPLICATI01� NO. . ,� ��- ; � - �,
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<br />(C) APPROX. LOCATION � �. , : ; ;.�. , �1.: i, ,
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<br />CHART ' � I M,i �
<br />(5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS '" =,�i � � I�,�•� i�
<br />SUANCE FEET� ' DRIVEWAY(TYPE) S 2�'�� �' ��jE
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<br />(7) ST1ITUS OF SEWER CH/1RCE5: ., �� . i: i,
<br />BOND = DISTRICT �� FOOTAGE . : ! , i;`
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<br />SEWER CONNECTION CHARCES �� • .
<br />YEAR � J TRUNK
<br />LATER/1L
<br />TOTAL CONNECTION CHARGES
<br />SEWER PERMIT FEE
<br />CATCH BASIN PERMIT FEE
<br />TOTAL SEWER PERMIT FEES
<br />(7) MONTHLY SEWER CHARGES:
<br />SEWER CUNSTRUCTION
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<br />TRUCK s
<br />LATERAL
<br />SEWER SERVICE
<br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN:
<br />INFOCOMPILED BY:
<br />APPROVAL:
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<br />CHART
<br />DATE
<br />DATE
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