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Ai 7R�SS J <br />BUILDING PP�'RMIT INFORMATION <br />2 � �a��,��� �-�,� �i��. <br />TYPE UF BUILDING 'S ,F .� DATE �/—/9 TS . <br />1) BUILDING PERMIT FEE ��7�� OQ <br />(A) PLAN CHECK FEE � 87� 5'� - <br />2) 1NATER SERVICE TO E3L• PAID B�FORE BUILDING <br />PERI�IIT IS ISSUED <br />(A) TO BE DETERMIN�D BY PLBG. INSP. � jNCfT <br />(B) EXIST.�_ �'f+TER SERVICE, APPL. NO. �y� <br />(C) LOGATION S-CiL��� 7�a /�.- � �~kt�� <br />(dG�'�I � i� � � d7�" �!I�J f,�.q /O�CHART ES%�' `�` � <br />3) DRIV�"v'JAY PERMIT TO BE PAID BE `RE B�U�NDITYPE) <br />P�R\4IT IS ISS:JED � FT. CD /J <br />;OTAL'� $ `h7�� �U <br />-}) STATUS OF S�1VER CHARGES• �(/ }�,c � � <br />BUND� DISTRICT _�_ 1 OOTAGE SF �'' . � V3 c 7,� �. <br />N, S, E, \V. p <br />1►t�✓��Iw „7�, <br />LAATDSCAP� NOTES SE�NER CONNECTION CIIARG � /QS �— <br />TRUNI{ ��(�. v � <br />Ex-• <br />j z�i-z. ZC�i` C9G� (�� I A'I' RAL 7i���� 2�'G-$_�I2..�t7 / <br />I` <br />� �Z4�""�S � SU/ <br />TOTAL CON�IEC ION CH�ARGE �S S�i�% . <br />SE�V�R PERMIT FEE $ � �• �G�,�. <br />CATCH BAS:N PLRMIT FEE <br />TOTAL SEWER PERMIT FEES <br />5) \10NTI3LY SEtiVER CHARGES: <br />SE�VER CO:VSTRUCTION: <br />S��VER S�RVICE: <br />LOCATIOi Or SIDE SEWE R TEE IN TH <br />G < � 8' " � /4✓kr�k-. � <br />? `�` �� <br />INrO COD4PILED BY <br />REVI�tiV: <br />.aPPROVAL: <br />TRUNI{ <br />LATERAL <br />iIAIN: CHART T' � <br />�.% t5' lt11_� <br />� This total mnst be �id before building permit is issued. <br />� \� <br />$ <br />S �� • od i� <br />� /. /S <br />��25 <br />� Z. --��"O <br />DATE <br />DA'I' E / �G// p /_[j _ <br />_��— <br />DATE �� L� �� . <br />�` <br />L <br />