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<br />� � ` ' [3UILDING PERMIT INFORMATION
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<br />� AODRESS -'r��� � A'��� � TYPE
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<br />; . (1) BUILDINC PERMIT FEE • E ��� �
<br /> (A) PLAN CHECK FEE 1 1 � a�
<br />� �� (2) PLUMBING
<br />� � (3) h1ECHANICAL ` ��1��— '
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<br />� (4) WATER SERVICE TO f3E PAID PRIOR TO EiUILDINC PERMIT ISSUANCE �-"��'� �
<br />� . (A) TO BE DETERMINED BY BLDG INSPECTOR I INCH
<br />' (B) EXIST. WATER SERVICE, APPLICATION NO.
<br />� (C) APPROX. LOCA710N
<br />;� , CH�RT ,
<br />;� (5) DRIVEWAY f'ERMIT TO B[ PAID PRIOR TO BUILDING PERMIT IS- �
<br />� SUANCE FEET DRIVEWAY (TYPE) b ��
<br />� R .
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<br />� '' p) STATUS OF SEWER CHARCES:
<br /> _ . BOND DISTRICT FOOTAGE
<br /> i N, S. E, W
<br />� :
<br /> i � NOTES
<br />� . 1111-g5 I�II/I �� I �' �
<br /> c.14�7�/l (o�$�
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<br /> n ; � , SEWER CONNECTION CHARGES
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<br /> � '...... �..,• � � !1 _.:., . YEAR TRUNK b ��� ,� .
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<br /> � ��,.. ; . LATERAL
<br /> •- ";' ' � • • TOTAL CONNECTION CHARGES b ���g _
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<br /> ' ., � ,. �. ;r �.. ' , $EWER PERMIT FEE b `_
<br /> ;"�' ' `'' T ;' 'I'�i"'�` ` CATCH BASIN PERMIT FEE � �q �
<br /> � w.,.. � ., �. l. L �.t �, . .. . . . . ry1 ``.�
<br /> - ,. TOTAL SEWER PERMIT FEES b '�
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<br /> :,.(7) MONTHLY SEWER CHARGES: '
<br /> � '"' ' SEWER CONSTRUCTION TRUCK b
<br /> , ,�• LATERAL
<br /> �,. ! SE,WER SERVICE
<br /> � j;;� APPROX. LOCnTION OF SIDE SEWER OR TEE IN THE MAIN:
<br /> � `�'-. ,
<br /> '� �" CHART
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<br /> �{ �;�j INFO COMPILED BY: DATE
<br /> ? ,.` APPROVAL: DATE
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