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� � <br />BUILDING PERMY: INFORMATION -S�� � N�L�,.._�c'� � i-���� <br />ADDRESS ,�'OI ���`� NO��'/IJ�V A-�/� �� l� � ���r��/� �����'��% <br />TYPE OF BUILDING ,yJ �j ,y��CX ' DAT� oZ �CJ-%� <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHEC': FEE <br />2) WATER SERVICE TO IIE PAID BEFORE BUILD[NG <br />PERMIT IS IS�UED <br />(A) TO BE L,.TER �4INED BY PLBG. INSP.�`� INCH <br />(h) EXIST. WATER SERVIGE, APPL. NO. <br />� /.� 1,�, (�J � � <br />� G� �, 0 �, <br />r� ��'�; j , l' ��. <br />(C) LOCATION /lialN ON ,��y1.IT S/�f�' 0� �O���f/ A�^,L'd,r <br />c� c� +,/'/JS / J F � C HA R T.$�-��� <br />3) DRIVFWA-i PERMIT TO BL PAID BEFORE BUILDING <br />PERMIT IS ISS�JED FT. ll/lt* (TY'PE) $/VC % r"E� <br />TOTAL� �w� 7./��� <br />4) STATUS OF SESS'ER CH?.RGES: /1/c�"'j/fi�iUf� <br />BOND DISTRICT FOOTAGE <br />N, S, E, W. <br />SE�VER CONNECTION CHARGES: <br />TRUNK <br />LATERAL <br />TOTAL CONNECTIOAT CHARGE <br />SE�VER PERMIT FEE <br />CATCH Br�SIN PERMIT FEE <br />TOTAL SE�YER PERMIT FEES <br />5) h20TdTHLY SEWER CHr:RGES: <br />SEWER CONSTRUCTION: <br />TRUNK <br />LATERAL <br />6EWER SERVICE: <br />$ J�� (� � <br />$ � Q��" <br />$_�O, DO <br />$ <br />�.�. " <�._ <br />LOCATION OF SIDE SE�VrR OR TEE IN THE MAIN: CHART ,G� .�C�-,� �. _ <br />��%�KCI y� y l'/1��/�T,�/ vF/�'I, /� �,4/ l�l�iFir� , F1,%i � J- a' ' 1)c��'P i4 <br />;%I��A��i �.v � � nF ,o�ldi' <br />INFO COh�PILEU BY: <br />�� <br />REVIEW: <br />L�� <br />APYRqvA <br />This total must be pa;.d beiore building permit is issued. <br />DATE Z-t y-7� <br />DATE ��?i�i s" <br />DATE .C�(�7-,�'� <br />