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BUILDING PERMIT INFORMATION <br />ADDRESS � ( 0�0 i�/�,yL.4irt� i%(�� <br />TYPE OF BUILDING aa �✓r���r r���,C`�J/(iJ�ir((r ��yfL,`�',� DATE a'/�-7,� <br />1) IIUILDINr, PERMIT FEE . ���P��`'b�L� $ ��a�Q�j <br />(A) PLAN CHECK FEE � ;�SS� � d <br />2) WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETER �4INED BY PLBG, INSP, INCH <br />(B) EXLST.�_ WATER SERVICE, APPL. NO.�(�'� <br />(C) LOCATION <br />CHART�%_- �� <br />3) DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING <br />PERMIT IS ISS:TED � FT. [�oNG',eEfC D/W (TYPE) <br />� TOTAL* <br />4) STATUS OF SEWER CHARGES: �n�'T,C,I �-��� <br />BOND DISTRICT ��'Od'I�A�GE <br />N, S, E, W, <br />SEWER CONNECTION CHARGES: <br />TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGE <br />� /`%SU <br />$iD�oZ<� U' <br />$ �� <br />$ � <br />$ '-� <br />SEWER PERMIT FEE $ --� <br />CA���3 A � RMIT FEE�$— �I�r�/Q,Qd <br />1'YVI�� <br />TOTAL SEWER PERMIT FEES $ , �/�,U� <br />5) MONTHLY SEWER CHARGES: <br />SEWER CONSTRUCTION: <br />TRUNK <br />LATFRAL <br />SEWER SERVICE: <br />TION OF SIDE SEWER OR TEE IN THE MAIN: CHART <br />�� i/._,i.,. .._ �_ _n ,n_ . .. „� <br />l!� aa��' s>. <br />INFO COMPILED BY: <br />��. <br />REVIEW: ��",� <br />APPROV��. �L� � <br />G1751 1 � <br />MThis total must be paid before building permit is issued. <br />$ -, <br />$ <br />$ %j'I�TL,�'�j <br />DATE L-z/- (,r <br />DATE� 24 h 5 _ <br />DA T E .2 :?i%'�� <br />