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. » Uuzl,Duu; rl:rltrr tin�c)i;rtA�rr�711 <br />1) BUILDING P1:II:IIT IEEE <br />• (A) rz,ntl ciIECI; rl:r. <br />2) PLUMBING <br />TYPE <br />$ <br />3) 19Ec1IANICAL $ //• C (J <br />4) 17ATrR SERVICE TO BE PAID BEFORE BUILDING OGr <br />PERMIT IS ISSUED <br />(A) TO BE DETERMINED BY PLBG. INSP. INCII <br />(Al EXIST. WATER SERVICE, APPL. NO. <br />(C) APPROX. LOCATION <br />V?jlt9IIART Ll,-4y <br />5) D?IVEWAY UR`= TO BE PAID DErORE BUILDIIIG PE,.;IT IS ISSUED FT. t':_:; :,;c,,—v/t9 (TYPE) $ / G --�_ U <br />G) STATUS OF SEW1-'R CIIAP.GES: TOTAL <br />IIOND III DISTRICT 'LC) FOOTAGE <br />N, S, L•', Fl. <br />NOTES <br />Sl 'lER CONNECTION CHARGES <br />YEAR '/6 TRUiat <br />LATERAL $ CQQGrr 00 <br />TOTAL CO?IiiEgTION CHARGE$ 4J •:•�� J V <br />���'�7 <br />S rs , •R PERMIT F17B <br />CATCB DASIII PEM11T rEE $ <br />TOTAL SEWER PERMIT PEES$ u6• D U <br />7) !iONT11LY SEWER CL'ARGES: <br />SEWER <br />C0NSTRUCTION: <br />k <br />`.TRUNK <br />) <br />$ <br />.LATERAL <br />$ 2 �h <br />SMER <br />SERVICE <br />$ 50 <br />APPROX. LOCATION Or <br />SIDE SEWE't OR <br />•TEE IN TiIE <br />MAIN:•!AQ <br />i� <br />;UeJL Ea:ex« 4-') <br />Y _ t/-LQ:z- <br />-re P1i <br />4t�r'i�oa <br />SZ� W O� <br />W-T <br />�-_I t� <br />'CHART <br />\l - <br />INFO CO`1P.ILEp BY: <br />DA'1'1: <br />ArPROV,1L: <br />DATF . <br />ct <br />