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,; <br /> iRI ING PERMIT I�VF'0:2r;(ATIOi�' _ <br /> ADDRESS_ c�"�7�-� �C� �,%����D ��/�' <br /> i ----- — <br /> TYPE OF BUILDING_ �[i'��L"-X _ DA'fEi�/__ �:�[�_���— <br /> 1) BUILDING PERMIT FEE Z���� •�� � ��� �p' <br /> (A) PLAN CHECK FEE $ (r�fJ, Sv <br /> 2) \'VATER SF.RVICE TO BE PAID BEFORE BUILDING V_�• <br /> PERMl'I' IS ISSU�D $ 2 c�C>. -- <br /> A) G BE �ETERMINED BY PLB,. INSP. INC?-I <br /> ll -- <br /> (B) EXIST. 1;_\TER SERVICE, APPL. NO. <br /> (c� LocnTioN � �" /LI,rJiiv ,Qf���df i/V C'EniTF�' DF ����'� �u <br /> CHART �--/�� � <br /> 3) DRIVEWAY PERMIT TO�E PAID BEFORE 73iJILDING �� l�����71 <br /> PERMIT I� ISSJEDJ-/�( FT. � (',e,�Tf�D/W (TYP�) $ ��5, �J/� <br /> /%•� T'6'�r�A�� ' $ ��'�i.s� <br /> -1) STAIUS OF SEWER CHARGES: <br /> BOND ._/.� DISTRICT c� � FOOTAGE � .S <br /> c — <br /> J�i'�+' 'u 3a'�--�-e-t'�-'-�� >--Z I ^ Ip�{_o� N,' S, r', �V, <br /> LANDSCAPE ATOTES ' SE1"J1:R CJNNECTION CHARGF:S: <br /> � TRUNK � S l�'L��, i� �% <br /> LATERAL ,^�q���') , U � <br /> TOTAL CONNECTION CHAFGE � �{(<,5;�7�� <br /> SEWER PERMiT FEL � .�Cj. C70 <br /> CATCH BASIN PERMIT FEE $ <br /> _ _ TOTAL SEGVER P�RMiT P'EES � S(j� � �� <br /> 5) il�10\THLI S�NFP. Ci-IARGES: <br /> S��t'�R GON�TRUGTiOI�'; <br /> TRUNE{ $ ,�_ _ <br /> LATERAL $ �,��'� <br /> sE�v�R sE&��ICE: �a1�.�1��'/'�'jF' <br /> I OCA'I ION OP' SIDE SEWER OT_� TEE IN THE MAIN: CHART� `(/-S-a��J'.,,$� <br /> r - <br /> �i i1 ��%�i' �O r'�D,�'�� ��' �1/�i�l�d t- �sn ' /'i9��i D� /YI <1 .�2 T <br /> .l�'f-f</:�OA/ � �I,u, .'<3e� — /��.t��y �i'��!�!%��/�� /��C. <br /> IATFO COMPILED BY: �-�� �1 ��+ � _ DATE /r-�-Jr <br /> REVIE\V: .���/��� , DATE �D — <br /> �'� TRAFFIC D �"SION ' <br /> /r f <br /> APPRO�'AL; �� �/,!; <br /> ` !EN(, NE NG DEPARTMENi �AT� - ,J/> <br /> °Tliis total mnst Ue paid before building permit is issucd. <br />��, <br />