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� L'UILDING P=:RPnIT INFORMATION <br /> AllDRES:i�/� �S � �� . {'.3/.��/%�GC/� / <br /> TYPE OI' BUIi.LI,VG� ���G/�A�l�C'/�' �F��C� DATE �J -z� <br /> 1) BUILDING PERMIT FEE '�� $ � 3�CG <br /> (A) PLAN CHECI{ FEE $�1 <br /> 2) SVATER SERVICE TO BE PAID BEF'ORE BUILDING � �, � � <br /> PERMIT IS ISSUED $ �`���U <br /> (A) TO BE DETERMINED BY PLBG. INSP. 7i�� INCH <br /> (B) EXIST. VY'ATEtt SERV.[CE. APPL. NO._ <br /> (C) LOCATION .+ <br /> CHART <br /> �) DRIVEti4'AY PERMIT TO BE PAID B�FORE BUiLDING ` <br /> PERh4IT IS ISS�JED _�r F7', qSPNA�.t D/�V (TYPE) g 1�� � � . <br /> ' TO'I`AL= 5 -� > <br /> 4) STATUS OF SE�VER CHARGES: <br /> BOND � DISTRZCT �5 ::'OOTAGE I D�n• � � <br /> N, , E, W. <br /> LANDSrAPE NOTES SE�Y.ER CONNECTION CHARGE : <br /> TRUNK � s a3�+• � 9 <br /> LATERAL �� � 5 a�S • �� _ <br /> TOTAL CONNECTION CHARr,F �5 ��• `� � <br /> SEiVER PERMIT FEE �y 3(i • o p <br /> CATCFi EiASIS\T PERMIT FEE �'.I'b� � �) <br /> � TOTAL SE�VER PERMIT FEES $ � O. 0 D _ <br /> 5) MOI�THLY SElVER CHARGES: . <br /> S�:WER CONSTRUCTION: � � <br /> TRUNK ^� .� 7 S <br /> LATERAL $ �.20 <br /> SEWP:R SERVICE: �a_ �I\C��1�� r' <br /> LOCATION OF SIDE SEWER OR TEE IN TH� MAIN: CHART lJ ' I�' ��`' S <br /> S�u'� io ��oPrer'-TY Ap�k��c �.�' L o� M•N. I,v r�onrr oi- �'�zov�.Q�YiAi°PGcx 10' ��PcO,�T <br /> �L --- Sio2�v1 S�wz�2 M.N, IN" FQv�IT oF C����oLCo ���G��rVla <br /> INFO COMPILED BY: C,�( , y�JL`.sZ�4 DATE �{ - �F - 7S � <br /> REVIEW: W�� � _ DATF. `r/ ���5 <br /> „ t[��7/' TRAI'FIC DIV ISION � —r l� <br /> ��1e�� � � r �:� �6%� � <br /> ��PP 'AL• , DAT��D - S <br /> E RiNG DEPA E <br /> �°This total must be paid before building permit is issued. <br />