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<br /> BUILDING PERMIT � NFORMATION , . ., ,:f�:, `
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<br /> ADDRESS � 43 / �. y�/ �� . TYPE"1�� ��
<br /> (1) BUILDING PEFMIT FEE (pZ�.� b '� �:�� ,
<br /> (A) PLAN CHECK FEE 4 • 7Z "''�r '
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<br /> (21 PLUIvI81NC S`gid� • `� '
<br /> (3) MECHANICAL � '� �_'
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<br /> (4) WATE"' SERVICE TO BE PAID PRIOR TO BUILDING PERMIT IS l,'A�10E
<br /> (A) TO BE DETERMINED BY BLDC INSPECTOR � IN�=H �i�'
<br /> (B) EXIST. WATER SERVICE, APPUCATION NO. �`�'��
<br /> (C) APPROX. LOCATION �� ,� ,� �.,;��'
<br /> , . . . . ... �.,,
<br /> ' , •, . ,�, . � ' -
<br /> CHART ' � ��'
<br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDINC PERMIT 15- � '�'
<br /> � t DRIVEWAY (TYPE) b 2O Ba ' I :!i
<br /> � SUANCE I�� �- / '� FE � a�y.
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<br /> (7) STATUS OF SEWER CHARGES: i ' ;: �� ', � �� ,� '( , �. :.i�.
<br /> BOND � DISTRICT FOOTAGE '��
<br /> N, S, E, W
<br /> � NOTES �
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<br /> ��cc. ur:e.�� �� ��� � l.uA'� �7.'ie ;��4a �
<br /> a,rto ti7�-g� • ,�,.�?�i�x,� ,aT 79�/ , �`,�; �
<br /> ''��T � ��e To '`,-
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<br /> � �y� '� �?9• — �L-� ,¢��Fx,o�,, , .
<br />� �e�,�,�. ¢�,. ma � d� �. � � j��
<br />�'i � Lt�� �/ , 7b 8E ,o G�csi�ra /����
<br />'j � - ,• SEWER CONNECTION CHARGES //�� �/ .
<br /> �' `�' YEAR S7 TRUNK S
<br /> � , . � .
<br /> ; LATERAL
<br /> • , ,•. : TOTAL CONNECTION CHARGES b
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<br /> � .. .: .. .
<br /> �
<br /> � ' SEWER PERIvfIT FEE 5 3�"��
<br /> � CATCH BASIN PERMIT FFE •
<br /> ` � ' .. TOTAL SEWER PERMIT FEES $ ��'
<br /> ,,, , .
<br /> , (7)�MONTHLY SEWER CHARGES:
<br /> E SEWER CONSTRUCTIUN TRUCK s
<br /> �
<br />:c LATERAL �
<br /> SEWER SERVICE
<br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN:
<br /> �
<br /> • � CHART `
<br /> ' � ,INFOCOMPILEDBY: DATE `-
<br /> APPROVAL• DATE _
<br /> �:
<br /> �
<br /> 5•84
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