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� ENGINEERING DEPARTMENT <br /> BUILDING PEF2MIT INFOR6IATION <br /> ! ADDRGSS �.�C� � �./ Q k�.S � � U P TI PE--�Ay.nQ <br /> 1) BUILDI.IG PERi�IIT FEE v <br /> (A) PLAN CHECK FEE S_____ <br /> 2) WATGR SERVICE TO BE PrIID BEFOR� BUILDING <br /> PERI�IIT IS ISSUED $ ,'Z 7 �, o0 <br /> (A) TO BE DBTERIdINED BY PLBG. INSP. / �� INCH <br /> (B) L'%ZST. ,�►- S4ATER SERVICE� APPL. N0. <br /> (C) APPROX. LOCrlTION (c �� C. /. 7 � {�/, n f f, !� o/ 04�[r.s A✓r <br /> • cHaxr N - a s <br /> 3) DRIV�IQIIY PERMIT TO BE PAZD BEFORE E3UILDING <br /> PERAIIT IS ISSUED Z.� FT. Cen � D/W (TYPE) $_ /O.SO <br /> TOTAL* $ <br /> 4) STATUS Or S�WER CHARGES: <br /> BOND DI3'PRICT F00'PAGE N , L'?� <br /> N, S, E, ��. <br /> . PCOw� wthl,o�o7�'i0f1 :^ . <br /> NOTES �—w SE�vEi: CUNN�CTION CHARGES: <br /> � .., Is1Fr 7�'o fIr/a � $rwt�' YEAR '7 �, TRUNK $_ - <br /> �V 4 �lC`� C e q�"/► � f//PAC6' LF�TBReIL $ = <br /> I E. 7Ro N.� S. QI/�y • S�� TOTAL CONN�CTION CHARGE. $_ <br /> l <br /> I b s/� w . G �� S. S . refwil't5r� SESrER PER�fIT FEE $ �O�so <br /> � j. <br /> 5�,�+�� � /fI`s�r •rl EoCft�I <br /> �v. �.� a„ �R Q Iler CAT�fi BASIN PERA;IT 'r'�E � S Z� , �� <br /> TOTAL SES�'ER PEPI�IIT FETS : SO. o0 <br /> 5) :•.OIJTHLY S�[•:ER CHARGES: <br /> S��dER CG:�STRUCTION: . <br /> TRUt:K $ <br /> LATERAL S �- <br /> SG�9T3R SEP.VICE: S.� rft/�_ <br /> i1P1%P.O.l'. LOCATION OP :iTUE SP:�4�R OR TEE IN Ti1E l�L+IN: 8 "MA�A in1T S Q//�tt� <br /> „r" 3�' ' S. .f S . PI� . _ 1D , hc «A _ — � <br /> CHART �iC � 2 T=S <br /> INFO COD1PILED EY: �_ _ DATE�_/�- 7b <br /> RF,VIE�a: -•------ DATE -- <br /> P?-:CJECTS UIVISICV <br /> APPROVAL: _ DATE_ _____ <br /> I;NGIi�h'"RINC llEPAR�:2EtiT <br /> * This total must be paid before building permit is issued. <br />