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ADDRES£' <br />TYPE OF IIUILDING <br />BUILDING PERMIT INFOR�4ATION <br />�� �i�D,���r� <br />c� � <br />cJ� . . _. <br />1) BUILDING PERMIT FEE ^.<<�, S��' <br />(A) P]�AN CHECK FEE <br />2) tivATEI: SERVICE TO BE PAID BEFURE BUILDING <br />PERi�4TT IS I55UED <br />(A) TQ BE DET'r'.RMII�'ED BY PLBG. INSP. �' IN;;Fi <br />/! <br />(B) EXIST. �VATE12 SER'VICE, AFPL. NO. <br />(G) LOCATION �<. a(T/vct-'/l' (�U�/3 � <br />�/L rN S�l . S. D� �,£ ���" C I-L4 R T �:�i.� <br />3) DRI�TE�YAY PERMIT TO BE YAID BEFORE BUILDING <br />PERrfIT IS ISS7ED /,S FT. (��j/�+/,?�i,� D/�t' (TYPE) <br />TOTAL' <br />4) STATUS OF SE�VER Cfi.ARGES: <br />BOND J,C DISTRICT �_ FOOTAGE <br />N, S, E, 1Y, <br />LANDSCAPE NOTES <br />SEtiVER COA'\ECTION CHARGES: <br />T R UiQK <br />LATERAL <br />TOTAL CO?d\ECTION CHARGE <br />SE�ti ER PF,RMIT FEE <br />CATCH BASL\ PERMIT FEE <br />TOTAL SE�S"ER PERMIT FEES <br />5) IvIONTHLY S.E�VER CHARGES: <br />SEWER CONSTRUCTION: <br />TRUNK <br />LATERAL <br />SEWER SERVICE: <br />LOCATION OF SIDE SEPJER OR TEE T_T�' THE MAIA': CHART L <br />�AP �;f`/�/iY' �i � � �%ST �/= /I�I, /-/. - /Y1,9 ��v ,��p,� <br />INFO COMPILED BY: :�Y� <br />REVIEW: � �� <br />TRA <br />APPROVAL: <br />�This total must be paid before building permit is issued. <br />/ ri" / LZI i � ! <br />$ `7. S"O ! <br />$ ���%, �JO � <br />s �d-'.5.. o �� ' <br />$`T�.�.cJ� / <br />$ ✓�C%. D CJ <br />5— <br />� <br />S . �J C7. C� L'J � <br />DATE /—/0''-Jr <br />DATE 9/�7 <br />! <br />DA T E �� %�' <br />