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<br />ENGIN£ERING DEPARTMENP
<br />T��T
<br />""�''v-� YERI�tIT INFOFUIJ�TION
<br />ADDAESS � �
<br />1) BOILDING PERMIT FEE �-- ,�
<br />(A7 PLAN CHECK FEE � � ` ��
<br />2) wATER SERVIC� TO BE PAID BEFORE BUILDING
<br />PERMIT IS ISSUED
<br />TYPE C / ; n � c
<br />S - ,I�'• --
<br />S �-,�, �._
<br />1
<br />� F��������
<br />2 ' S -70�`'-=
<br />(A) TO BE DETERMINED BY pLBG. INSP. 7
<br />INCH '
<br />� r:. r;;�',.,..<.
<br />(II) EXIST. �yj !�' WATER SERVICE, APPL. N0. �{t ! �� r� , � � , G"-,
<br />(C) APPROX. LUCATION /� ,.�
<br />' �/• ' �' % �
<br />, �
<br />G r'. f r'.. ,,,
<br />CHP.RT S- l l 2_�S - f I I.
<br />') �-'.- : ��i:11' PERMIT BF. PAID BEFORE BUILDING �
<br />a � _ ;. . ,., ,
<br />_.i e IS ISSUED !:;?, FT. C., ,., � D�W (T
<br />--�_ YPE. ) . $ 3 9 . � , �
<br />� 1 ;�:,:::5 OF SEWER CHAT;GES: TOTAI,* g
<br />- •�___ DISTRICT FOOTAGE p
<br />-- - �/ 2 r� �,�,• n
<br />v, s, E,_� W, '�—
<br />� ti0TE5—�— S�«R COtiNECTION CHARG£S:
<br />z�' `�„ `�' `' �_ "^�; YEAR � 7 C-
<br />f "- �-=r�+t_�=f'a:hc�;rr TRUNK a _ -
<br />i I cenn�cf tc .ua�n .r� 93R� $�
<br />�Iar Msr• LATERAL $ �_,
<br />/ d,�Gc�'ch 5o�)��S f� ��n; , TOTtiL CONtiECTION ClinR�£ $
<br />' � a � i< i r� � � e� S.
<br />�') � S� S �• / SEFIER PERMIT FEE
<br />l`•, ; v� c �.rcr /t1..� E7C-1'Et.a�$ S 3 0, o�
<br />�C rvs5 S, (op � o�' �rcPYi'�.L CATCH BASIN PEFtMIT FE ��a
<br />I �a $�_
<br />d TOTAI, SEWER PERt�:I^_' FEES $
<br />' - �iF�EA CHhRGES: �w
<br />;;:� , SEWER CONSTRUCTION: —
<br />'� /h��.J /_��„ ,i. /',%if �t�'� f�13iQN.�_',1ii ��"7 � —_
<br />TRUNK $
<br />-i�-� -------._
<br />` ��t; j�: LATERAL
<br />$ —.
<br />S�WER SERVICE:
<br />` '• .':�IOY OF SIDE SEWER OR TEE ZN THE FiAIN: �
<br />. 7- „
<br />P'1 !a / �._. � 3 � ° o e: p u � �� �. �� , ,
<br />f�BD lJi' i'L� Qo CHART !t T�
<br />---� BY: �'.r-.��•,- io 7i' c/ .
<br />/ JN9� ��iv�
<br />,"�- • !i%"i�ff�
<br />$ �`1�T��ED
<br />DATE �-�c,_7G
<br />—�._
<br />DATE
<br />� �✓Q.S�}�4.��
<br />� DATE
<br />. � i/
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