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� • •4' <br />�.:::;. <br />�_�.r•. <br />`V�I �� <br />� <br />BUILDING PERMIT INF�RMAT'ION <br />ADDRESS �Q2a C�^""' A"� — TYPE_ <br />(1) BUILDINC PERMIT FEE <br />(I1) PL/1N CHECK FEE 351. 3Z —3a�-S3 � <br />(2) PLUMBING <br />`y�^ (�3)VMECHANICAL , � • <br />(4) WAT[R SERVICE TO BE PAID PRIOR TU BUILDING PERMIT ISSUANCE <br />;(A) TO BE DETERMINED BY BLDG INSPECTOR 3 �� INCH <br />�__, _(B) EXIST. WATER SERVICE, APPLICATIOM1! NO. <br />' (C) , 11PPROX. LOCATION <br />. <br />.� <br />/ �� <br />� % /�I <br />,... <br />';. <br />.. - CHART <br />,..(5) ORIVE4YA1' PERMIT TO BE P/11D PRIOR TO BUILDING PERMIT IS• <br />� SUANCE FEET DRIVEWAY(TYPE). S oZiL� <br />, ', � s <br />,;;�. . <br />.,.;,.. � .. . <br />; ii � <br />':`:�u(7.)::STATUS OF SEWER CHARCES: , <br />' �"'`� � BOND � DISTRICT FOOTAGE <br />N, S, E, W <br />s��° ..:,.�8-�, <br />SEWER CONNECTION CHARCES <br />YEAR TRUNK <br />LATERI�I <br />TQTAL CONNECTION CHARGES <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />' �.. p) MONTHLY SEWER CHARGES: <br />, �� SEWER CONSTRUCTION <br />i .. <br />, ,: <br />• . ; <br />:; -; <br />_ i.__ <br />` <br />�.. <br />_ ^ � 1_... <br />s � z>r�: <br />ysri <br />s �a � <br />, _. <br />s .3(� oU. _�'-. <br />S <br />TRUCK s <br />LATERAL <br />...` SE\NER SERVICE <br />•APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />;�. <br />.1:` � �' <br />�.:.J .-. <br />- `INFO COMPILED BY: <br />,,; <br />""APPROV/�L: <br />`�?2i_ <br />i, .. <br />4.: , , <br />,'� , �nr <br />CH11RT <br />DATE _ <br />DATE _ <br />