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r'`� ,� <br />�, � ' <br /> FOR OFFICE USE ONLY <br /> ADDRESS <br /> (1) BUILDING PERMIT FEE g <br /> (A) PLAN CHECK FEE <br /> (2) PLUMBING <br /> (3) MECHANICAL <br /> (4) STATE SURCHARGES <br /> (A) BUILDING CODE <br /> (B) ENERGY CODE <br /> (5) DRIVEWAY PERMIT <br /> $ <br /> (6) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE $ � �/ V'�• 0�l/� <br /> (A) TO BE DETERMINED BY BLDG. INSPECTOR INCH /�� 2�7�'lD <br /> (B) EXIST. WATER SERVICE.APPLICATION NO. -�/Z2�Z <br /> (7) STATUS OF SEWER CHARGES: <br /> BOND D.3TRICT FOOTAGE <br /> N, S, E, W <br /> ':.ji^� <br /> SYSTEMS DEVELOPMENT <br /> WATER �OD ;':r_:. <br /> SEWER /D 13 '" °�' <br /> TOTALORD. FEE _ �lD/_3 <br /> SEWER CONNECTION CHARGES <br /> YEAR TRUNK $ <br /> LATERAL <br /> TOTAL CONNECTION CHARGES $ <br /> SEWER PERMIT FEE $ �d - <br /> ,.;; .. , <br /> � � �`'•"'j�=. <br /> j . ;�.,,a:. <br /> �;. <br /> I t L I:ti <br /> i �. . . � . � � . (.���� <br /> � � I <br /> � <br /> . � . . ' ' 1 1'�`lro" <br /> � . ... . ... . (.• . _ � �.3 . ,�Sj <br /> t' - <br /> . . .. . ... . �. ' ,. <br /> .. ' . . ,' . �-�, . . .�..�� <br /> . . . _ . . �� i . 'r' ' � <br /> ' '. I . , ��ts� <br /> � � ' <br /> � <br /> �v <br /> ti <br />