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D�.,�RTMENT OF COMMUNITY DEVELOPMc.. f SERVICES `` �� <br />BUILDING P��Fv11T !NF'��dMAI'ION <br />ADDRCSS l4/d A Z3 �--�c.tukte�! {�v�., TYPE Gm��! 7�c.�0[.�c <br />(1) BUIiDINC P[RMIT FFE (,.�ooc�• °'� � Z'ZS- Q'D <br />(A) FLAN CHECK FEE _ �. t�r_`> �u� <br />(2) F'LUMdING �to. v o <br />(3) MFCNANICAL l �. C� o <br />(4) WATER SERVICE TO [3E PAID PRIOR TO BUILDING PCRMIT ISSUANCE <br />(A) TO BE DETERMINED BY BLDG 1NSPECTOR _1. INCH <br />(B) E;(IST. WA'iER SERVICE, APPLICATIO�i NO. <br />��.Q�' (C) APPROX. LOCATION L�� MA�.c� .d-�op2�,c f Z R�- <br />nl o� � o� L��u4Yna ���Rr �—/ co <br />3� g , cso <br />�"'r�c.n� su.PP�Y <br />(5) DRIVEWAY PERMIT TO BE PAID PRIOR TrJ BUILDING P[RMIT IS- <br />S�JANCE 2- 11 FEET %SPH��.T DRIVEWAY(TYPE) $ � 7' � <br />�� , C�1 ��— <br />(71 STATUS Of SEWER CHARGES: v� i9 �.�b <br />� <br />BOND � _DISTRICT �2 FOOTAGE �S <br />=� N 5, E, W <br />NOTES <br />SEWER CUNNECTIQN CHARGES � <br />_J ��. <br />YEAR � � TRUNK �J 5 � 2� � • � � <br />LATERAL y,z:� �'' 34 S• c� � <br />TOTAL CONNECTIUN CHARGES 6'77'� �3`?- �� <br />,2 3 S�' �- <br />SEWER PERMIT FEE �aS/� $ <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES S <br />(7) MONTHLY SEWER CHARGFS: <br />SEWER CCINSTRUCTION TRUCK $ �• �S <br />LATERAL 2 � 2S <br />SEWER SERVICE _������ <br />AFPROX. LOCATfION OF SIDE SEWER OR TEE IN TN� MAIN: 8�� M1,�iu� � Bc �-0-t�.i,l�e� <br />/��E �'� I�bT To p�l. laPP2.0� 13t�r P @R� M 11 �µ"43 � l.�QP2� <br />P�� 'D�s,a �-�- PI�.. ____._ _CHART �—s-Zt3-S <br />INFO COMPILED BY: <br />APPROVAL: <br />DATE <br />D�TE <br />