Laserfiche WebLink
t]U1LL1:vU t't.::.���1t L�rvtt.�i:+ itv.�+ <br /> ADDRESS �<J C J r fC✓��-S � C�/C��'U ;<�.�� <br /> TYvE OF L�liILllI;:G ��, � r�, D!1TE �i - %.-s ?� <br /> 11 SliILDI:'G YER\IIT :E:. 5 �� �i V � `� <br /> (A) PLAN CHECYC FEE S 5%. Q� '-- <br /> 2) tCAT�R SFR�'ICE TC RE PAID BEr ORE L'•i?Ii.D:'�v �, [), (7 �-7 ✓ <br /> PER:,_I: IS ISSiJED � <br /> (A) TC EE DETEF.�LIED BY PLSG. INSP. �� ?:��=i'. <br /> (II} E1ST'. \':ATEtt SER�'IGE, APFL. �O. <br /> �C) '_CCATIO� _ <br /> r 7.� _� <br /> Ct-'i�D 1 J xc\ / ���� <br /> �) DRIC:�:.SF PER\i?T TO 5E PAi� BEFC=?E £�L'i:.'J?::G <br /> PER\:Ii IS ISS:r.D „?3 FT. C.^ vC'�'.�'iE D ';': (T1'PFI $ ��. SU T-r�1 <br /> • TCTAL G� O•'�JV <br /> = i ST�TL"S OF SE'.':E•^. C:L4RG': � - ?�o II`� OC� — <br /> P.C�J � DIST�IC': � � FCCTAGE <br /> \, S, E, ti�', <br /> — :_:;,:DcC�. �r •,C-r.c ��1',-ER CC'�.`:�C�iG\ C�=�=.GE�: 6�9��� . <br /> - TRL\F; P�. 5 �4G • C� iJ _ <br /> LATERAL S `� <br /> TCTAL CC\\ECT:C'� C__=.3G:� S ��a� U D <br /> SE�t'ER PER\:IT FEE /t�""7t�� �O • n C' <br /> CA'ICH BASL'� �r.P.',:=` =�- 5 — <br /> TOTAL SE�'�ER PERSIIT r'=ES S -� �'� �-' <br /> 5) :vIO?':T'r.;..T SE�tiER CFi�RGES: + • <br /> SE�ti'ER CO\'STRtTCTION: - <br /> TRU?�Fi $ ���� <br /> L:�TER=.L 5�--- <br /> SE«'ER SERVICE: S �,' '� �� <br /> LOCATIC\ OF SIDE SE\1'ER OR TEE I\ THE A1AI1: CH.4RT � ' �' ��J��� , <br /> .�i�L�]'� 'Tb �'�L /'rii��-'c'� �73 � ��Sr- cF iti�.N . �tV ��'rn-� vF <br /> ��CFI% `�� b0�l:ii L�lC(.� ,� /'� d�� � (�l'rCi �� Y f�li <br /> INFO CO�i?ILED BY: � , /'/�,.���� DATE (,n -/ 7-?„L, <br /> REVIE�V: DATE � ' � <br /> Ii:ef FIC DICISION <br /> APPRO\'AL: �"Zlc_..GL�� Dr^.TE �- �CJ�- 7.S <br /> E\GII�EERING DF.PARTI�SEICi <br /> This total must be paid before buildin� perrzit is issued. <br /> �.1 <br />