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i'.M ` � <br /> ENGINEERING DEPARTMENT <br /> BUILDING PEPMIT TN1�0}2M71TION <br /> . rwDxESS l c3'LC� • � �r� �J brz . TYPE -s�7�. . <br /> 1) BUILDING PERMIT FEE ' $ <br /> (A) PLAN CHECK FEE $ <br /> 2) 4iAiER SERVICE TO BS PAID BEFORE BUILDZNG • <br /> PERMIT IS ISSUED s <br /> � <br /> , . <br /> (�A) TO BE DETERIdINED BY PLSG. INSPo INCH <br /> (B) EXIST. � WATER SERVICE, APPL. N0. � <br /> . , (C) AFPROX. LOCATION <br /> , CHAR7.' <br /> 3) D3IVES4AY PrRMIT TO BE FA':D BEFORE BUILDING <br /> PaR�1IT IS ISSUEL � FT. _ D/P�1 (TYPE) $ <br /> TOTAL* $ <br /> i 4) SinTUS OF_SLATER CHA&GES• <br /> SO:cD �_ DISTRICT_ �i�' _ FOOTAGE <br /> ' N, •S, E, W. <br /> NOTES SEWER COhNECTZON CHARGES: v <br /> XEAR -1 -1 TRUNR $ �D� ' � <br /> 3— �co — 248- 00 /�G�' ri����r� $ ` <br /> . , TOTAL CO C 0 HARGE $ �O�• �— <br /> SEWER• PERAIIT FEE S �� ' � <br /> CATCH BASIN PERMIT FEE S <br /> • TOTAL SEWER PERAiI'i' FEES $ . � � � <br /> 5) ::J::�E:LY SEItiER CHARGF.S: — <br /> SEWER CONSTRUCTION: <br /> . TRUNK $ O �Z � <br /> I.ii'.rER�1L $ <br /> SEWER SERVICE: $ ���—� , <br /> APPR�S. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br /> CHART - <br /> INFO ��>:PILED SY: DATE <br /> REVIEit: DATE <br /> ' PROJECTS DIVISION <br /> APPROI',1L: DATE <br /> , ENGINEERING DEPA1tTMENT <br /> --.e: -. <br />