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DkrARTMENT OF COMMUNITY DEVELOPMtr1T SERVICES <br />BUILDING PERMIT INFORMATION <br />ADDRESS 3S�) P '' TYPE __ <br />(1) BUILDING PERMIT FE $ <br />(A) PLAN CHECK FEE <br />(2) PLUMBING <br />(3) MECHANICAL <br />(4) 'WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br />IA) TO BE DETERMINED BY BLDG INSPECTOR INCH <br />(B) EXIST. _— WATER SERVICE, APPLICATION NO. <br />(C) APPROX. LOCATION <br />CHART <br />(5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- <br />SUANCE FEET DRIVEWAY(TYPE) $ <br />a, <br />(7) STATUS OF SEWER CHARGES: <br />BOND DISTRICT FOOTAGE _ <br />N, S, E, W <br />NOTES <br />SEWER CONNECTION 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 TRUCK $ — <br />LATERAL — <br />SEWER SERVICE <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />INFO COMPILED BY: <br />APPROVAL: <br />9 1-79 <br />CHART <br />DATE <br />DATE <br />