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0 <br />�DDRESS / 7/� <br />IiUILDING PERAtIT INFORMATION <br />G �l ��Vi�2 /�vE <br />TYPE UF BUILDING �S� / � DATL�3-� �% <br />�� <br />1) BUILDING PERMIT FEE <br />(A) PLAN GHEGK FEE <br />2) tiVATER SERVIGE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETERMIN�D BY PLBG. INSP. -� INCH <br />(B) EXIST. «AT�rt SERVICE, APPL. NO. <br />(C) LOCATION ��L . /YJf��� /`���2� `� G � <br />� �� ,�__ CHART N — /�.� <br />3) DRIVE�VAY PERMIT TO IIE PAID }3 FORE BUILDING <br />PERMIT IS ISS�JED � FT. �IL% D/��' (TYPE) <br />4) STATUS OF SE��IER CHARGES: <br />BOND DISTRICT <br />LANDSCAPE NOTES <br />TOTALr <br />f�4,��� �/�f� <br />FOOTAGE <br />— ii, S, E, W. <br />SEIVER CONNECTION CHARGES: <br />TRUNK <br />LATERAL <br />$ [33. <br />$ � �, s-o <br />$ �,Z� o O <br />, <br />`��'• 4�"Ll7s, <br />/�.f , <br />� lD, .� o al,.i, <br />h .-�_ <br />.Q 7,�s.t <br />$ <br />5' <br />TOTAL CONNECTION CHARGE � �� <br />\ <br />SE�4ER PERMIT FEE $ �� � C� <br />CATCH BASIN PERMIT FEE <br />TOTAL SEtiYER PERMIT FEES <br />5) MONTHL i SE�1'ER CHARGES: <br />SEWER CONSTRUCTION: <br />5 � <br />� �U • � U <br />TRUNK � - _ <br />' LATERAL $ __ <br />SEWERSERVICE: • \� ��SU <br />),�ATION OF SIDE SEWER OR TEE IN THE MAIN: CHART �`�/-'a� -.i~ <br />�'' ��Y /s'1,�J� �v �� v x .�a ` l F M. ✓. — . ccl <br />�KnJ �, �cl �/1��� �f �� 11u' La ( CJ�� <br />INFO COMPILED BY: <br />REVIEW: <br />APPROVAL: %�-� <br />E <br />�,' <br />, �??(.�C���-�. <br />�°This total must be paid before building permit is issued. <br />DATE, � - <br />DA T E .3 � 7.-�� <br />DATE � �/7S <br />