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� • , <br />}<,.,. M r r � <br />Y <br />BUILfJ9N� PERMIT INFORMA.iION <br />.��� <br />Cy <br />t" � <br />��� <br />w � <br />�� � <br />� y <br />��o1� <br />HC <br />UH <br />��8 <br />� y .r.0 <br />�H� <br />h+ y <br />C U� <br />���� <br />�t�� <br />nti <br />ADDRESS TYPF — <br />i1) BUILDING PERMIT fEE $ <br />(A) PLAN CHECK FEE <br />(2) PLUMBING <br />(3) MECHANICAi. <br />(4) WATER SERVICF TO BE PAID PR!OR TO BL'ILDING PERMI? ISSUANCE <br />(A) TO B[ DETERMINED BY BLDG INSPECTOR INCH <br />(B) EXIcT, ___ WATER SERVICE, APPLICATION NO. <br />(C) APPROX. LOCATION __. <br />CHART <br />(5) DRIVEWAY PER,ViIT TO EE PAIf� PRIOR TO BUILDING PERMIT IS- <br />SUANCE FEET DRIVEWAY(TYPE) S <br />S <br />(7) STATUS OF SE�NER CHARGES: <br />BOND DISTRICT <br />NOTES <br />fOOTAGE �O��e Al� <br />c� Ic c:� �w( <br />N, S, E, W <br />SEWER CONNECTIJN CHARGES <br />YEAR TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGES <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />(7) MONTHLY SEWER CHARGES: <br />SEWER CONSTRUCTION <br />S �'1'�''L'_" <br />3 <br />5 3Q" <br />S 3�` "' <br />TRUCK 5 <br />LATERAL <br />SEWER SERVICE <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />INFO COMPILED BY: <br />APPROVAL: __ <br />�ie� <br />CHART <br />DATE <br />DATE <br />; <br />