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� /� 7- �� <br /> .. . � � <br /> ENGINEF,.ic�,,;: �DEPART�9ENT I� � <br /> BUILDING PERMIT INFORt+f]\TION �3 `� �f <br /> n T � � <br /> ADDRESS �{—�Q ( Z {�,L�.�.l..( I.,.I C� `�'D!J TYPE j�� <br /> 1) BUILDING PERMIT FEE Q- I�`T l4 ` �� S � �p�j. � <br /> (A) PLAN CFiECK FEE $ �� , �„ <br /> 2) WATER SERVICE TO BE PAID BEFORE BUILDING • <br /> PERMIT IS ISSUEA S 2�1 �� <br /> (A) TO BE DETERidINED IIY PLSG.1 INSP. JI� INCH r�'��' z-� �� <br /> I-ticc,�� f g . �c� <br /> (B) EXIST. � WATER SERVICE, APPL. N0. � <br /> . , (C) APPROX. LOCATION <br /> CHART <br /> 3) DRIVENAY PERMIT TO BE PA.ID BEFORE BUILDING .� <br /> i?£R+IIT IS ISSUED � FT. Q,s3- Pt� . _ D/W (TYPE) $ I Z ' � <br /> .. TOTAL: $ SO Z• OO <br /> 4) S;hTUS OF SE�+IER CHARGES: - <br /> BO:r'D� DISTRICT �cI FUOTAGE • ' <br /> - N, S, E, W. <br /> � - <br /> ai�t . <br /> � f� ' NOTES SEWER CCNNECTION CHARGES: <br /> YEAR TRUNK $ ���� �v <br /> 'j ',.',�; , ' I �A TERAL $ �/2�`�D <br /> j �,, �--��- zc�z oa P�R I n / . <br /> � TOTAI. C�NECTION CHARGE $ rJ�/•`.�0 <br /> � i� �' SEWER• PERIdIT FEE $ =��' �U <br /> , r _i, e <br /> i '"" . �, CATCB BASIN PERMIT FEE $ <br /> r� � TOTAL SEWER PERh;IT FEES $ ��� �G <br /> � 5) ::J:��i:LY SEt�'ER CHARGES: <br /> � - • SE�+IER CONSTRUCTION: <br /> ��,�. <br /> , ' TRUNR $ j •/S <br /> � �i, � <br /> �� ;��.;1�� I.ATERAL $ �,'Z�5 <br /> SEj+1ER £'RVICE: $ �Z � �0 , <br /> APPRJS. LOCATION OF SIDE SEN)ER OR TEE IN THE MAZN: <br /> CHART <br /> INFO .:0}:PII,ED BY: DATE <br /> REVIEt�: pATE <br /> ' PROJECTS DIVISION <br /> APPRO�'aL: DATE <br /> , ENGINEERING DEPARTMENT <br />