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!:NGI.Ili:Cl(U:G AM) Cp:1:;t1))1'1"i .°'•1;ItVl:l : i <br />AUl)1'.IiSS --L40L v'� (jC'/L.>E �J✓Lr> O '.TYPE <br />"F <br />3.) <br />BUILDING 1'):11:SIT FEE 4,dl�U'•D[J <br />- <br />(A) PLAN CHECK FIiE <br />• <br />2) <br />PLUMBING <br />• • <br />3) <br />19ECIIANICAL <br />$ <br />//. C�i U <br />4) <br />l?ATER SERVICE TO BE PAID BE17ORE BUILDING <br />PEW -SIT IS ISSUED <br />(A) TO BE DETERMINED BY PLBG. INSP. 3�INCI1 <br />(SS) EXIST. STATER SERVICE, APPL. NO. <br />(C) APPROX. LOCATION 8 d.0 <br />0�7 <br />N 9V&4 ti4(LtaLTt=o �..�.a 1='%��SNA'.tT W-4i <br />5) <br />MIVENAY Prn%,!T TO BE PAID BEFO!)E BUILDING <br />PZXMIT IS ISSUED FT. j�� p,:Eq{, D/Ir (TYPE) <br />$ <br />��•��C� <br />G) <br />STATUS OF SEWER CflAP,GE.^.: TOTAL <br />DO'.D lit DISTRICT rLO. FOOTAGE <br />- No S, Be V1. <br />NOTES <br />7) 13ONTRLY SMER CHARGES: <br />SEIIER CO"lNECTION CHARGES <br />YEAR % 5 TRUNK $ i� ��0 •J U <br />LATERAL co <br />TOTAL CONIIIE TIO,T CHARGE$ <br />s : , r, rrmsrr F):r•. <br />CATCH BASIN PLM11T FEE $ _ <br />TOTAL SES•!ER PERMIT FEES$ O G <br />SESIER <br />CONSTRUCTION: <br />TRUNK <br />-LATERAL <br />SEVER <br />SERVICE•, <br />APPROX. <br />LOCATION OF <br />SIDE SMER OR <br />'TEE IN THE MAIN: <br />&';UJ'./LTLZ) <br />L. .- <br />i= /r.c_fr/ _off <br />-r�� PfL' <br />OE <br />CHART-�--- <br />INFO C0:)PII1 j) BY: DATE <br />APPROVAL: DATE . <br />