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<br />BUILDING PERMIT INFORMATION
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<br />�{�DDRESS �3� ��� 'a� TYPE Slwk� �ILrY �tT,
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<br />�ts'. ��(1) BUILDING PERMIT FEE %� �BB• � S 5 . B O
<br />� (A) PL^N CHECK FEE -- � 2�
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<br />;�.i..�;�'(3) MECHANICAL ZZ •dD
<br />(4) W11TER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE ��' �a
<br />''(A) TO BE DETERMINED BY BLDG INSPECTOR � INCH �
<br />"" (B) EXIST. W�TER SERVICE, APPUCATION NO.
<br />_.`_". ' (C) APPROX. LOCATION
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<br />�� CHART
<br />,'^!(5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PFRMIT IS- n
<br />�',. ;��� SUANCE FEET DRIVEWAY(TYPE) S `�'QD
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<br />''''.;'.�•,.;; (7) STATUS OF SEWER CH/1RGE5:
<br />� ?' BOND �DISTRICT FOOTAGE
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<br />SEWER CONNpEC.T�ION CHARGES
<br />YEAR � / TRUNK
<br />L/1TERAL
<br />TOTAL CONNECTION CHARGES
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<br />SEWER PERMIT FEE
<br />CATCH BASIN PERMIT, FEE
<br />TOTAL SEWER PERMIT FEES
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<br />�.�(7) MONTHLY SEWER CH�RCES:
<br />SE�Y�R. CONSTRUCTION TRUCK S
<br />' "'� `�' LATERAL
<br />� ' ' SEWER SERVICE
<br />'. �;;/�PPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN:
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<br />� `r DATE
<br />INFO COMPILED BY:
<br />� �,,A?PROVAL: D�1TE
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