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ENGINEERZNG DEPARTMENT <br />SUILDING PERMIT S*IFORMATION <br />ADDRESS � �� �� OC�-��h! L�L-� TYPE <br />1) BUILDING PERMIT FEE -�`j"], CO¢�• � <br />(A} PLAN C21ECK FEE <br />2) WhTER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(A) TU SE DETERldINED BY PLBG.' INSP. � INCH <br />(B) £XIST. WATER SERVICE, APPL. N0. <br />.� F-;e <br />$ �� ' U o <br />s1oi. � <br />s 2��•'°� <br />��o.c,. 'G i• r'� <br />Ni����. ��o a. <br />(C) APPROX. LOCATION l n" G.Z A-P�'L�X Lo � f� r <br />�. 6�' �U . Q I L.. CHART UJ -� 8 <br />3) D�iVEWAY PERMIT TO BE PA D BEFORE SUILDING <br />PER�fIT IS ISSUE�'L� FT. � D/W (TYPE) <br />�� TOTAL* <br />4) S;ATUS OF SEATER CHARGES: <br />BO:dD T� DISTRICT 2 F3 FOOTAGE <br />N, S, E, W. <br />SEWER CONSTRUCTIG":: <br />SESdER CONNECTION CfiARGES: <br />YEAR �� TRUNK <br />LATEF�AL <br />S 2 � . ot� <br />S �� ' S� <br />$ </U, O� <br />�- <br />5 <br />TOTAL CONNECTION CHF.RGE $ �U.OG <br />;^ ; ,,� �; � _no <br />SEWER PER2dIT FEE ���r ^,1 �{ $ -��' <br />CATCH BASIN PERtdIT F�E ���r�'� 5 � <br />TOTAL SEWER PERI�iIT FEES� �G� C%O <br />,.<. <br />L �-': <br />�. <br />TRUNK $ �• �'� <br />I.ATERAL S <br />SE��'ER SERVICE: $ G• j r, <br />APPROS. LOCATION OF S=DE SEFIER OR TEE IN THE MAIN: �vNnr I 4 1= i � <br />r,c �_ w. �c� t_.e-s I2 -t -,rn. "r <br />INFO :..�?:PILED BY: <br />REVIEtC: <br />• PRO.7ECTS DIVISION <br />APPR�\',1L: <br />ENGIN�ERING DEPARTMENT <br />DATE <br />DATE _ <br />DATE <br />