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, ENGINEERING DF.PARTMENT <br />BUILDING PERMZT INFORMATION <br />ADDRESS _� <� ^d `L. '%� E� �r r I7�r''�: �, I(i c� TYPE S f� <br />1) BUILDING PEFMIT FEE �(�J7jB'�� S.__I%Z•O� <br />(A) PLAN CHECK FEE � $ �.00�- <br />2) i9ATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETERMINED BY PLBG. ZNSP. �_�_ INCH <br />$ 2eo. o0 <br />�G/.G/ ✓ � . U U <br />/`/�r_l; p G <br />(B) EXIST. !' WATER SERVICE, APPL. N0. �-- " <br />(C) APPROX. LOCATION A��� ,Q,�', Rq y;n -!B�Aj e{ ,� �T' <br />,�/„r�t�!{rU �.IUc� CHART /� . <br />3) DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED 2!' FT. f�t�.ti D/W (TYPE) -7�-�43 $ «.i0 <br />— , <br />TOTAL* $ <br />4) :iTATUS' OF SEWER CHARGES: <br />BOND� DISTRICT �'_Z?'` FOOTAGE �"— <br />N, S, E, �Q. <br />_., ., � zF 7 _ _ a_.-� �..�..i <br />SEWER CONSTRUCTION: <br />SEW�R SERVICE: <br />�X. LOCATION OP SIDE SEWER OR <br />:/'�'a w �i �.� a— .� S. T n 2� F. <br />���.�,..,., <br />SEWER CONNECTION CHARGES: <br />YEAR �'_�_ TRUNK <br />LATERAL n' <br />TOTAL CONNECTION fH/: �Fr, Ji <br />l� r� �.. / b <br />, <br />SEWER PEFMIT FEE�J � �l'+�F �. <br />CATCH BASIN PERI�IIT FEE <br />$ / 9S. Do <br />S 3rz.sn_ <br />$�'^ �0 7. s�o <br />$ -' �O. �%Q <br />$ _" <br />TOTAL SEL9ER PERMIT FEES $ ?.,(�, oti <br />"� <br />r%'� 3� �%y��G <br />TRUNK �� $ I • IS <br />LATERAL <br />IN TH� D7AIN: <br />„ � 4 ' �v �' CH. <br />INL'O COMPILED BY: , / <br />REVIEW: <br />PROJE(:TS DIVISION <br />APPROVAL: <br />ENGINEERING DEPARTMENT <br />Mn� <br />�� <br />DATE <br />DATE <br />DATE <br />* This total must be paid before bUilding permit is issued. <br />$ 2. 2� <br />$ 2.�b <br />� i .- 2 ,a ✓� <br />0 <br />