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DEPARTMENT OF COMMUNITY DEVELOPMENT SERYICES � <br /> BUILDING F'ERMIT INFORM,4TiON � ' <br /> P.DDRESS �-2 C , /�'�c: ��ic.-�- TYPE __� ' �� <br /> (1) f3UILDINC PCRM.IT FEE ��7, =�'�'��- $ _ �=7. U_D <br /> (A) PLAN CHECK FEE ��' �� �� ��� <br /> (2) PLUMBINC �G�•OU <br /> (3) MECHANICAL 2�' �SL-- <br /> (4) WATER SERVICE TO DE PAID PRIOR TO dUILDING PERMIT ISSUANC[ ��GO. oa <br /> (A) TO BE DETERMINL=D BY DLDG INSPECTOR _. INCH <br /> (B) EXIST. \NATER SERVICE, APPLICATION NO. _— <br /> (C) APPROX. LOCATION G" G ��= MA�JJ�t3"�dr �F`=' <br /> , E>F,�_CF �/!�.(�«����HARl GU - 3z D - <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDINC FERMIT IS- <br /> ' SUANCE FEET DRIVEV� AY(TYPE) S <br /> 9� <br /> (7) STATUS OF SEWER CHARCES: <br /> BOND �DISTRICT FOOTAGf - <br /> , N, 5, E, W <br /> �, NOTES <br /> �3v� vFv�-�.��T R"�� <br /> C�,� 7d`L- �t� <br /> ��L� 2- 3s,. E.1/v. /.U7c_�x'.E7'TE✓� �; <br /> �F",P-�, �339. o� i; <br /> SEWER CUN�VECTION CHARGES <br /> � � <br /> YEAR _ g=' TRUNK 3 ��`�`�� �� �' <br /> 3�j5' � OU �; � <br /> LATERAL �� f'- <br /> .- <br /> TOTAL CONNECTION C!iARGES $ � � J` �v i� � <br /> �� � <br /> � �U I � <br /> SE\'JER PERMIT FEE $ � � � <br /> �- <br /> CATCH BASIN P�RMIT FEE � � <br /> TOTAL SEWER PERMIT FEES $ ��"`�� � � <br /> � <br /> (7) fv10NTHLY SEVVER CHARGES � ; , <br /> SEWER CON5TRUCTION TRUCK 5 �' �' <br /> LATERAL � �� <br /> SEWER SERVIC�c �,/ 4 <br /> APPROX. LOCATION OF SIDE SFWER OR TEE IN THE MAIN: � �" <br /> �i7�/F3{h�-�� 7G t-7C _ '� ` <br /> 11y/»r UZ.Lt? [�' •�' M f! /7� �^ dP�vPDx� �=oF7 ���P. � i <br /> CHART ��?'�`�� <br /> INFO COMPILED BY: _ DATE <br /> APPROVAL: DATE <br /> t <br />