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3-I LcI- �Iz�Df� ' �� TYPE 'SF-e. <br /> ADDRESS 2 p�, 0 0 <br /> (1) BUILDINC PERMIT FEE � Cc�� OSD-B� $ � � �� <br /> (A) PLAN CHECK FEE /J p _ o a <br /> (2) PLUMBING 8 _pa <br /> (3) MECHANICAL 2 3S• <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PE�R,P��IIT ISSUANCE � „�oK Su <br /> (A) TO BE DETERMINED BY BLDG INSPECTOR=-.�t�---INCH <br /> (B) EXIST. WATER SF!tVICE, APPLICATION NO. <br /> (C) APPROX. LOCATION ��� �' � T`j'T�"�' �'��� �'w��K <br /> t'l�-c � �� �' tr� �CHART `-�'"7S <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- ,2 �� <br /> SUANCE 2 � FEET Gd"'c. DRIVEWAY(TYPE) $ <br /> S <br /> (7) STATUS OF SEWER CHARGES: �o�r��� <br /> BOND DISTRICT FOOTAGE <br /> N, 5, F, W <br /> NOTES <br /> SEWER CONNECTION CHARGES <br /> YEAR �— TRUNh S <br /> LATERAL <br /> TOTAL CONNECTION CHARGES $ <br /> a3yb�� $ 3o. s a <br /> SEWER PERMIT FEE I <br /> CATCH BASIh PERMIT FEE 2I�� <br /> TOTAL SEWER PERMIT FEES $ <br /> (7) MONTHLY SEWER CHARGES: TRUCK $ ' <br /> SEWER CONSTRUCTION _ <br /> LATERAL <br /> B • SC� <br /> SEWER SERVICE ���� �P� � <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: tZ`� <br /> 2 '�T v-F o+� �, eF '�-�oraY /av� -C'�. lN r.n.�si� taRw[t9t <br /> M u ��� �'-DW4Wos�r CHART T 30 -'24 s <br /> l�l C9 �" �' `Dt-Ptt+ � <br /> �R.+r�nY <br /> DATE <br /> INFO COMPILED Bl : DATE <br /> APPROVAL: <br /> 41•79 { <br /> } � - � �"" i+s -'ru. E'" r',d-�r.� <br /> . .. :.�.nr ���^�_.�R"",��i� y�.x}^.., <br /> � <br />