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'•:� t;�;� <br />�'�� ,.� <br />BUILDING PERMtT INFORMATION <br />ADDRE55 ���� �'����'� TYPE ylNUC_G�� ii�Y. rS <br />(1) BUILDING PERMIT F�E �'�Q� 't� � S_��1. S-� <br />(A) PL�N CHECK FEE <br />(2) PLUMBINC �`o•O a <br />(3) MECHANICAL -OO <br />(4) WATER SERVICE TO BE PAID PRIOR TO BUILDINC PERMIT ISSUANCE CpSD•� <br />(A) TO BE DETERMINED BY BLDG INSPECTOR �> INCH <br />(B) EXIST. WATER SERVICE, APPLICATION N _ <br />(C) APPROX. LOCATION _ _ <br />CHART <br />(5) DRiVEWAY PERMIT TO BE PAID PRIOR TO BUILD!'�G PERMIT f�• � <br />SUANCE FEFT DftIVEWAY{TYPE) S_ Z�' <br />S __ <br />(7) STATUS OF SEWER CHARGES: <br />80NJ _�-.—DISTRICT <br />NOTES <br />.,fi'�- ./�0 C. L/'t'ICrt7'-'� �r�� <br />O�21� 117i -SS� <br />l�z Ci /��. BC� <br />�,ut�i � ?r .00 <br />� ��—o%� <br />FOOTAGE <br />N, S, C, W <br />� <br />SEWER CUNNECTION CHARGES <br />YEAR �7 TNUNK f •��� `D� <br />f.ATERAL g�' �� <br />'OTAL CONNECTION CHAKGES 1 ��' �� <br />SEWER PERM[T FEE S �'�� <br />CATCH BASIN PERMIT FEE __ `'� <br />TOTAL SEWER PERMIT FEES S �p'� <br />1 <br />(7) MONTHLY SEWER CHARCES: <br />� SEWER CONSTRUCTION TRUCK <br />LATERAL <br />SEWER SERVICE <br />APPROX. LOC1ITION OF SIDE SEWER OR TEE IN THE MAIN: _ <br />� <br />INFO COMPILED BY: <br />APPROVAL: <br />�wr' <br />S <br />CHART <br />DA'f E <br />DATE <br />