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d <br /> ,•.� �,�,,,, } <br /> �L.• ; <br /> BUILDING PERM �T INFORM4TION : <br /> s <br /> r <br /> �1DDRESS � S�C 3 ll �_� ,�,..�E� TYPE f <br /> (1) BUILDINC PERMIT FEE g S`� O,S('1 ,. ; � ; <br /> (A) PLAN CHECK FEE �i5/, 3a - 3as a (� 3 Z ' ' � <br /> (2) PLUMBING SS p� ? <br /> (3) MECHANICAL 3(,Cd , ; <br /> r <br /> (4) WATER SERVICE TO BE PAID PRIOP. TO BUILDING PERMIT ISSUANCE �O:SO� <br /> (A) TO BE DE1 �'tMINED BY BLDG INSPECTOR 3��.( `' INCH � <br /> (B) EXIST. WATER SERVICE, APPLICATION NO. i� <br /> (C) APPROX. LOCATION � , �� <br /> � <br /> F <br /> , . . <br /> ; <br /> _CHART 4 <br /> (5) DRIVEWAY PERMIT 10 BE PAID PRIOR TO BUILDING PERMIT IS- - ' � <br /> SUANCE FEET DRIVEWAY(TYPE) 6 a�� � <br /> ; <br /> b � <br /> � <br /> (7) STATUS OF SEWER CHARGES: ' �.' <br /> BOND �_ DISTRICT FOOTAGE � ; <br /> � <br /> , _ N, S, E, W <br /> (. <br /> . ����'�- <br /> C(Itp� l l �/ —�—� <br /> �Q sG <br /> � <br /> �-Q.�►� � 1� � •. <br /> S Gnr-t/�- � �l� { <br /> �05� <br /> SEWER CONNECTION CH�RGES � <br /> YEAR TRUNK s 3 3n �'._ <br /> LATERAL 2J Q L_ <br /> TOTAL CONNE:.TION CHARGES S �a 5 � <br /> �: <br /> SEWER PERMIT FEE b _�lY °�' i <br /> CATCH BASIN PERMIT FEE <br /> TOTAL SEvVER PERMIT FEES S <br /> (7) MONTHLY SEWER CHARCES: <br /> SEWER CONSTRUCTIO�: TRUCK 3 , <br /> LATERAL <br /> :; <br /> SEWER SERVICE �; <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: � <br /> CHART � <br /> .. <br /> ;. <br /> INfO COMPILED [3Y: DATE i' <br /> APPROVAL: _ DATE � <br /> 1 <br /> 1' <br /> j <br /> 1 <br /> .� <br /> i/Bt <br /> :1 <br />