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�iwn�r <br />� 1 <br /> �J �� <br /> ; <br />'� �l!l�UlNea PER�1A1'P INFOl��A�'ION <br /> l <br />:� _ . �j , <br />� ADDRESS / �� �/�� � <br />� (1) BUILDING PERMIT FEE $ �/� � � , <br />�? (A) PLAN CHECK FEE -�-`� <br />'� (2) PLUMBING . . <br />� .,"(3) MECyANICAL <br />� (4) STATE SURCHP,RGES <br />� (A) BUILDING CODE _ <br /> y (B) ENERGY CODE � <br />''i (6) DRiVEWAY PERMiT <br />,� , $ a �� � <br />� (o) WAi ER SERVICE TO 8E PAID PRIOR TO BUILDING PERNIu ISSUANCE $ �C�� <br />� (A) TO BE DETERMINED BY BLD3. INSPECTOR p�_ �NCH . , _ <br /> r� (B) EXIST. WATER SERVICE APPLICATION NO. <br /> S� (7) STATUS OF�CHARGES: ,�„ <br />� BOND DISTRICT FpOTAGE N, S, E, W <br />> <br />; <br /> ORDINANCE 1171-85 <br />', WATER - ��� � <br /> SEW ER �'{nG"[—O�. 7���� <br /> TOTAL ORD. FEE __ �af�� — <br /> I y��„I �� SEWER CONNECTION CHARGES <br /> � c�� <br />' �I � YEAR TRUNK $ � . <br />; ���( ��l V� � LATERAL , <br /> i <br /> � TQTAL CONNECTION CHARGES $ <br /> _ � SEWER PERMIT FEE $ ����� <br /> � ,�. _';:� � <br /> , <br />,'� �" �" ' <br />,{ i <br /> a <br />�� - ' --� � <br />� Y � � r ��� � „ <br />,d �„ylM_ tl�`-..l'-, I � <br />,�.� . � � � .. . <br /> c��-. _l-: <br />� � ' "'�,� ,.� <br />;� <br />'j • � r <br /> t�.,, ��`.S�`��� L � <br />'� r ' _ . <br /> l� {ti^�.'�;�: • <br /> i; _ . . <br />,: <br />(I <br />� �:,,�. <br /> '�:i..�.�..,. '����, <br /> ���� ♦ . <br />