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F'111: C I'l'1' li:il; ;)i1LY - ' <br />_ . � <br />ENGINtiERING Ai4D COP1AlUNI'PY SE2VSCIiS <br />� I3UILDING PERh1IT INCORh1ATION <br />ADDRESS �� �J � �=a/.�/J /""U� — <br />1) IIUILDING PLR:SI'P F�C �� �6./�- �� <br />(A) PL11t] CIIL•'CK rEE <br />2) PLU.IBING <br />3) MECIiAt1ICAL <br />9) ?dAT�lt SERVICE TO IIE P71ID BEFORE BUILDING <br />PERAIIT IS ISSUSD ' <br />TYPE ��ti%'�•- ' <br />$ G G / � �-�`�' <br />$ � �� � l� �•- <br />$ 7Jf' l � <br />i.• <br />$ z.�, �U <br />,�� � �� <br />$ -` � -�" <br />(A) TO IIE DBTERb1IVED 9Y PLBG. INSP. I INCH <br />(R1 �XIST. C7ATER S�RVIC�, APrL. NO. <br />/ r/ <br />(C) APPRO:{. LOCATIOt7 /r � •r� /�.i'!;'_,�'),� == �7 �i% �'� <br />�E/G �.�rJ �� tlE � CIiART '�J— ���% � <br />5) DRIVE?•IAY PERPIIT TO IIE PAID BEFO?2E BUILDING N J7/.2f� �> L [J(� <br />PP1:,�II".' IS rsso�n2- 25 FT. ,C�� !.-�l5% D��'� �TYP�) S L�-�' <br />G) STATUS OF SEf�liR CHARG�S : TOTAL $ ���, S< _ <br />BOND �DISTRIC`P ��� FOOTAGE I 2-`� <br />N S E VI <br />-� _ �� - 0%� - co0 <br />✓ <br />'/) i i0:!'I'I'.I�Y SliS9F,R CHARGES: <br />SI:I9L•'R CO:dSTRUCTION: <br />� • � • <br />S�T9GR CONNECTION CEtAR�ES <br />YEAR �� TRUVK S ��� 2�� <br />LATERIIL $ I �� • ZSI <br />TOTAL CONDIECTION CHARGE$ �J Z Ci. �_� <br />SE�;TL'R PER�'tIT FEE S � D• D U <br />C�1TCH BASIN P�RCiIT F�E $ --' <br />TOTAL SES•lER PERPIIT F�ES$ Jin• '�' U <br />TRUNK $ <br />LATERIII, $ <br />�J , -] S._ <br />4��� <br />Sii`.•IE!2 5ERVICE S �,���'���, <br />\i'T_�I:O\. LOC�\'PION OF SIDE SEWE't OR T�E IN TIIE M71IN: �'� /fi/.rJ; ��: ��'T <br />� �'F' � � �a2�-r-; � ,v ?1-�t� cr 9 % r1" /�� Ot-` <br />NI�-!. �x,�r "UO�,c� s 3� 1�u� c►ir+aT J— I��-Zk-4- <br />�:;:'O CO:!YI7�ED BY: <br />rin�r� <br />�rr2ovnr.: - — nn2�� <br />