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�t', l� <br />� <br />BUILDING PERMIT INFORMATION <br />ADDRESS TYPE s�"�li� ���� �t� <br />(1) BUILDINC PERMIT FEE �di�9�'� s 'o4''S� <br />(A) PLAN CHECK FEE �'3' E'� <br />(2) PLUMBINC �D'��� <br />(3) MECHANICAL �� ��� <br />(4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE �OO-O(7 <br />(A) TO BE DETERMINED BY BLDG INSPECTOR INCH <br />(B) EXIST. WATER SERVICE, APPLICATION NO. _ <br />(C1 APPROX. LOCATION _ <br />CHART <br />(5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- <br />SUANCE FEET DRIVEWAY(TYPE) S 2C'� <br />'� f <br />;. , <br />(7) STATUS OF SEWER CHARCES: <br />BOND � DISTRICT <br />NOTES <br />SF'S�� U7it.,r � <br />6�Lr� l /7� - 85"_ <br />l-�.ya I?9. v= <br />r_�� <br />�-� <br />FOOTAGE <br />N, 5, E, W <br />SEWER CONNECTtON CHARGES <br />YEAR g� TRIiNK S��PT pC.`= <br />LATERAL ��' ¢' �''� <br />TOTAL CONNECTION CHARGES S �n��8s � <br />-�-,., ' <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />� TOTAL SEWER PERMIT FEES <br />W <br />(7) MONTHLY SEWER CH�RGES: <br />SEWER CONSTRUCTION <br />s c�.�r�� <br />_----- <br />TRUCK S <br />LATERAL <br />SEWER SERVICE <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />:, <br />�,; •.. <br />INFO COMPILED BY: <br />APPROVAL: <br />s�aa <br />CHART <br />DATE <br />DATE <br />�� r ' <br />