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, <br /> � . �;l ' <br /> . ' . � ' , /� , '� � <br /> ( \ .iJ �` <br /> eNci►aee�snac n�in COP141UI7I•rx :;Lavzc�;; � <br /> AUILAIWG PiiiU4IT INCORMA'CION .r <br /> .. - � <br /> ADURESS � _ 'PYPE _ �� Q�-Q/Vf <br /> 1) DUILDING PCIL'!IT F�E �% i� ��[}�'Yr� . �r'' $ (�(�2 , () 0 <br /> . (A) PLAt1 CIISCK FGE $ /��,,� . �j7jQ'7 / <br /> 2) PLUMDING � • $ ��,,�] 4, (�<.) <br /> . 3) M�c�tnNicnz S ¢ , pd <br /> �) [JAT�R SERVICE TO IIE PATD DErORE SUILDING <br /> • PERMIT IS ISSUfiD ' $ ,�JQ. ��� <br /> , �3�h5 • / <br /> (A) TO, BE D�TI3RMIN�D BY PLBG. INSP. �G INCH �`'� �P��� <br /> (R1 CXIST. • S•�ATER SSRVICE, APFL. N0. <br /> (C) APPROX. IACATIOt7 3" G. 1 Mo�� la' 9" � t-� LU �'�u� ��i��u.� �.Sp <br /> L_ � .� I.nn�� G�ti�� � Ofi � �2�W CHART /l/— c/ ¢ <br /> • Li �� <br /> 5) DRIVE}•JAY PERFSIT TO BE PAID IIEFORE BUILDING � <br /> � • • PER�fIT IS ISSUED Q- � FT. ���(�� D/4� (TYPE) S 2'� � �U ', <br /> f • i <br /> 6) STA;US OF SE[1ER CHARGES: TOTAL S L 9 �E�• � , <br /> • BOND DISTRICT FOOTAGE /�-IC'��j,2��c-1J/> <br /> . � 47, ' S, E, FJ. <br /> N��g SE[+IER �ONN�CTION CHAR�ES <br /> , � YEAR . TRUN� S ; <br /> � ' ' LATERAL $ I <br /> � <br /> I <br /> TOTI►L CONNECTION CHARGE$ � <br /> ' � � <br /> � SE'':ER PERMIT FEE $ �jU � DC� 1 <br /> CATCH BASIN PERMIT EEE $ ZD • �� i <br /> i TOTFIL SES•aER nERf4IT FEES$ 1 d ' �v � <br /> � ' <br /> j 7) ?iONTHLY SEf9GR CHARGES: � <br /> � SIiI�ER CONSTRCICTION: TRUNK $ - ' i <br /> � <br /> w_^�- <br /> t • L]�TERAL $ � <br /> ' SE'RER SERVICE $ ��� 7��1� � <br /> APPROX. LOCIITION OF SI�� �EWE_2 OR TEE IN TTIE MAIN: '8 � N>,cli,v � Di- G��4,0�„t <br /> Tf�� r.v ,v� � , � Co•? F�, ss c�r �' Iio c-7 ; � Zo'F"t � �:�ZF� :, cJ- <br /> n.� N . 207�-, � G�z,�ti„� c�tnaT �.� /-�'/- �q-� <br /> INPO CQMPZL�D IIY: DA'CF. <br /> APP I:OVAL: DATI: <br />