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ADDRESS <br />TYP� OF BUILDING <br />r_.�� <br />�f�YRAVJ��9/uOl! Y���� <br />vIIT INFORMATION <br />�� ,.��. �'�,r� <br />1) Bi3ILDING PERMIT F�E <br />(A) PLAN GHECK FE� <br />y� PE?2MIT ISRIS UED O BE PAID BEFORE BUILDING <br />(A) TO BE DETER �INED BY PLBG. INS ,� O?. _ INCH <br />(B) EXIST. WATER SERVICE, APPL. NO. <br />(C) LOCATION �s �� fa�• � �� � <br />� <br />L CHAhT ,(,s/ /( r <br />3) DRIVEWAi' PERMIT TO BE PAID B�FORE BUILDING <br />PERMIT IS IS.`'i�JED /'% FT. `vs,Q• D/W (TYF' /�$�'�� <br />° ��� lj/'/i7 ,,L � Q <br />T07A� $ �C��� � <br />4) STATUS Oi� SEWER CHARGES: � it/�1�= t�ssrM• ^'' <br />gpVD � DISTRICT ? FOOTAGE ZD � G ��a <br />— N , S , W . � ..�' �,.c..-c� <br />SE\vER CONNECTION CHAP,GES: � 'r�'"" <br />LANDSCAPE NOTES TRUNK � ' � �� �' �-% - <br />� .�, o o �_.�,.. <br />_. — ��"::-- ",;,.,^—i'>I LAT�fiAL f3�JO,�o � ?��,�' 4s� <br />�: £ <br />TOTAL CONNLCTIO���J'I�1���$_�:�' � _ <br />SEWER PER.MIT FEE �,Jl ✓> �_ ��. � <br />CATCH BASIN PERMIT FEE $_ <br />TOTAL SEWER YFRMIT F�ES �a �D • <br />� <br />5) \40NTF?LY SEWER CHARGE:i: <br />SEW�R GON£TRUCTION: TRUNK $ • � 0 <br />LATERAL $ Z• �o <br />SEWER `uERVIC�: ��"'"' <br />e <br />LOCATION OF SIDE SEWER OR TEE IN THE MAIN: CHAR <br />, , , i -' i�ai ..._, ' L <br />COMPIL�D DY: <br />REVIEW: <br />APPROVAL: <br />. • / .t <br />v � �S � <br />. <br />��°This total must be paid before building permit is issued. <br />i7i�TE f �'-�9 �--��",. <br />DATE 1(��/7S`" <br />DATF. //� Z� %J�' <br />