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ADDRESS IoUll . ' )o0 <br />TYPE OF BUILDING S. �. A <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />2) WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETERMINED BY PLBG. INSP. 131�1 INCH <br />(B) EXIST. WATER SERVICE, APPL. NO. <br />(C) LOCATION7 d I oC 1 � "/l`� A/A/e/�%�5 <br />< V r4 0ti l2ynq &aw�i0 4DPHA-R'T`1Q <br />3) DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED ?-Z FT. /W (TYPE) <br />TOTAL* <br />4) STATUS OF SEWER CHARGES: <br />BOND DISTRICT % / FOOTAGE <br />N, S, E, W. <br />SEWER CONNECTION CHARGES: <br />TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGE <br />SEWER PERMIT FEE <br />CATCH DASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />5) MONTHLY SEWER CHARGES: <br />SEWER CONSTRUCTION: <br />TRUNK <br />LATERAL <br />SEWER SERVICE: <br />DATE a- % %r_ <br />$ f-P Ll D (-) <br />$ / S . C� 0 <br />$ /-? S D IkiF <br />sSo? ys o- <br />$ /do'1. a <br />$ ,�JI5 0O. <br />$ �46S,o(I <br />$ <br />$.s?0.ao <br />$ /' i., <br />$ a, a <br />$ <br />LOCATION OF SIDE SEWER OR TEE IN THE MAIN: CHART d-'sr-ao;7-41 <br />1 i U F TC� /n/oLf�Ty G�/vf �i%J c%mac C� / n <br />INFO COMPILED BY <br />REVIEW: <br />APPRO V <br />�91 <br />*This total must be paid before building permit is issued. <br />DATE L _ 0-7 S" <br />DATE <br />DATE <br />G <br />