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<br /> . ' • � • _ ! • . _ � . � .. ' • d '.
<br /> ' BUILDING PERIv:IT IAT.FORMA'�'ION
<br /> L1
<br /> ADDRESS (� I � � :' �- ��e'�,.� ' �" % � L ��
<br /> - .
<br /> TYPE OF BUILDING �/:�) ���'� /�'j i�, :' �%'l,'_' „__ DATE � , � �.l
<br /> 1) BUILDING PERMIT FEE ' $ J"� /� /i �
<br /> (A) PLAN CHECK FEE $ iC.'U, i,S-
<br /> 2) WATER SERVICE TO BE PAID BEFORE BUILDING c� _, \_'
<br /> PEE2MIT IS ISSUED $
<br /> (A�O BE DETERMINED BY PLBG. INSP, i� _ INCH
<br /> ) EXIST. WATER SERVICE, APPL. NO.
<br /> (C) LOCATIOPI i���� t' �Z l�/r��,Y,�, P/ ,;',.,, �i� ' L�, ,�- � 1L.•
<br /> �
<br /> ,/-r'lrrL-' f� � �� - �4�:�fn !LS;r'-• ' -'�!�' "��i i;'L CFiART i�l - �
<br /> /
<br /> 3) DRIVEWAY PERMIT TO BE PAID BEFORE BI7:LDING
<br /> PERMIT IS ISSUEI]s�`3S"r �"•�T. �n�Y�L'i%jE ll/W ('.CYPE) �4 .�4%(� C:�
<br /> .i c�:'r s'r ii.S�D,::_�.�� '�� r -
<br /> ' --TOTAL;: � /���� 1, �> `.,
<br /> .
<br /> 4) STATUS OF SEWER CHARGES: /���� �i��� �1'�'� '
<br /> BOND DISTRIGT FOOTAGE
<br /> - N, S, E, W.
<br /> ��8�'AP-E NOTES SEWER CONNECTION CHARGES:
<br /> /„ TRUNK $ --
<br /> �., „':; �V<�T _ L/n � IV ' . —
<br /> � LATr.RAL $
<br /> ��4TClf if,�?s - (Occ,� C:'�� � TO�TAL CONNECTION CHARGE $ J
<br /> ,, � J () ��'•ct ;` ..<� _- --� 2
<br /> �.''-[3 1 �o.�T�°!Z <S�t �'�'�����E.�� SE4VER PERMIT FEE ��� $ �J(=�rC) c"�
<br /> CATCH BASIN PERMIT FEE =• $ ��`� << � C i
<br /> I
<br /> TOTAL SEWER PERMIT FEES $ . Cn(l ��� (" �
<br /> 5) MONTHLY SEWER CHARGES: !�� �/�'��'� .
<br /> SEW.ER CONSTRUCTION:
<br /> TRUNK $ —
<br /> LATERAL $ �"
<br /> SEWER SERVICE: $ d��<'��'��%;�'��
<br /> LOCATION OF SIDE SEWER OR TEE IN THE MAIN: CHART �'� -�n�0 ,.'i �S
<br /> ,�,'�iu� [ � /tiln�ilu� /��i'ir ' � � li � � 1! � U!, / , i ,. n � � �
<br /> � / �7b l� h � ('R ! If'iL� [).<i';�--,�, , `-J �/-�//p��C`i' l � % l
<br /> , . 7 t0 'Z.
<br /> � i�iiic�'� i;i; � '�:;�i,a��h ' oi= Ir.:;��Ki � — .:'�y.� ,.i'�';� �,�i r�'/ .STA � ��f"���N�Y
<br /> INFO COMPI D BY: �/f�i�. `�77., C l ; DATE ' • i c` i+'
<br /> REVIEW: �I � DATE-� :
<br /> TRAI'FIC DIVISION
<br /> APPROVAL: � ?y7 ���7J2'/, 0� �Nl�� N� � ,,�DATE� /2 S
<br /> E -II�E.ERING DEPA M
<br /> �This total must be paid before Uuilding permit is issued. �
<br /> . �
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