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ENGINEERING DCPRR'i'l4EN^1 <br /> �UILDING PERMIT INFOR117�TIOiS <br /> I /�� <br /> ADDRESS' f ��G U �- l,::G��J�CI TYPE ._JI � <br /> 1) fl'JILDING PERldIT FEE Z "t: r.�? � �'v $ /� �D <br /> (A) PLAN CFIECK FEE $ _. pp <br /> 2) StiAiER 5ERVZCB TO BE PAID BEFORE BUILDING • <br /> PE£�t:IT IS ISSUEL $ <br /> (A) TO BE DETERidZNED F�X PLBG., INSP. -�� INCH �� { �� �v <br /> , Oo <br /> �B) EXIST. WATER SERVICE, APPL. N0. l��',>%a � � <br /> . (C) APPROXe LOCATION CP �T � E> -r /���.c� Go� C�-vT <br /> 4 - cxaRr <br /> 3) D3ZVES5AY PERMIT i0 BE PAID BEFORE BUILDING � �'zj <br /> PER'•fIT IS ISSUED / S_ FT. ��L' D/W (TYPE) � $ , J <br /> TOTAL* $ 2�L�q�� <br /> 4) S�nTUS OP SEATER CHARGES: <br /> BO:dD !+ DISTRICT Z.3 FOOTAGE <br /> N, S� E, W. <br /> NOTES SEWEH CONNECTIQ*1 CHARGES: <br /> YEAR TRUNK $ <br /> . Y,ATERfiL $ ��"��'�y <br /> e TOTAL CONNECTTON CHAP,GE $ <br /> .=� <br /> ' Q SEWER PERIdIT FE� l, ' ��� i I �� $ ��' �U <br /> h � <br /> CATCH BASIN PERI�SI7' FEE � ,� $ <br /> ` L. <br /> TOTAL SEWER PERb?IT FEES $ ��• �O � <br /> 5) ::J::�::LY SEh'ER CHi�RGES: <br /> SEWER CONSTRUCTION: <br /> . TRUNK $ �•�S <br /> LATEFtAL $ Z • Z S _ _ <br /> SEWER S'F.tVlCE: $ 2 '�� <br /> APPRJS. LOCATION OF S17E SEWER OR T^cE SN THE MAIN: �T ,�'1H�,��r� //3 ,�T <br /> �!(? �,� /v//� n-r �v,c- cJ .�1��r�v=_rtu �C .)o��_c,i�. �SPF/1O� � �r <br /> �f�n=r� ��T �i•�'. Z��.vE.. " �' �r-Je�eso,,� r CHART � - -G -�.- <br /> INFO �0>:PILED BY: DATE <br /> REV I£i�: DATE <br /> � PROJECTS DIVISION <br /> APPROI'AL: DATE <br /> ENGIN�GRING DEPI�RTMBNT � <br /> �' <br />