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. �.7 �
<br />' DEMRTMENT OF COMMUNITY DEVELO�MENT SERVICES
<br />BUILIyING PERMIT INFORMATION
<br />(� t3iaZ�. �a� �. TYPE S u.s4LE �i�. K�
<br />• ADDRESS S � � ¢� � 0 a ,
<br />_:� (1) BUiLDING PERMIT FEE 2 23� 23�` s �,� 7�9�...'
<br />:f_ (l1) PLAN CHECK FEE $B•DD ', . . ,
<br />' • (2) PLUMBING 3(o-OD ' " �
<br />,•��'"�(3) MECH,\NIC/1L '
<br />'�__(4) W/1TER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE
<br />(o O
<br />, (I1) TO BE DETERMINED BY BLDG INSPECTOR _ INCH
<br />� (B) EXIST. WATER SERVICE, APPLICATION NO.
<br />,•:
<br />•-- (C) APPROX. LOCATION
<br />- CNART U' 3�5 -ZQ-�
<br />, u�,(5) DRIVEWAY PERMIT TO B FEETID PRIOR TO BUILDRI EWAY( YPE) S
<br />; � SUANCE
<br />`': . S
<br />9t•
<br />��''(7) STATUS OF SEWER CHARGES:
<br />� GE
<br />BOND � DISTRICT F��T^
<br />N, S, E, W
<br />NOTES
<br />5 �'Z ��
<br />�, _-.' z�� 484-83
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<br />,:
<br />SEWER CONNECTION CHARGES
<br />YE/1R �8s TRUNK
<br />LATERAL
<br />TOTAL CONNECTION CH/1RGE5
<br />SEWER PERMIT FEE
<br />; `,.., ,., CATCH BASIN PERMIT•FEE
<br />� "" � • TOT/1L SEWER PERMIT, FEES
<br />I, . _.C1?: J ..
<br />(7) MONTFiLY SEWER CHARGES:
<br />SEWER CONSTRUCTION
<br />20. DJ
<br />„ ., . �
<br />. . - � J :.; _
<br />s Z'10•C9d �
<br />s Z"I (� • C9 O "
<br />s �0 •O�. .-�
<br />s 3Q . C9C�
<br />TRUCK s
<br />LATERAL
<br />� � SEWER SERVICE
<br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN:
<br />,:^_:� `. ._
<br />INFO COMPILED BY:
<br />. APPROVAL:
<br />`�"�' ; . ,
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<br />�L�._'�'':r! i.4i:en i ::Y'J�—*n:,n
<br />_ CHART �'{'`
<br />DATE
<br />DATE
<br />6
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<br />•�.::�,
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