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ENGINEERING DEPARTAfENT � <br /> _ BUILDING PERMIT INFORt4ATION � <br /> i <br /> ADDRESS_ G�3 7� /���l� je` ��r . TYPE <br /> - —.��� � <br /> 1) BUILDING PERt•fIT FEE /� G, ���_> ���`� $ �O ,^,o <br /> (A) PLAN CHF.CK PEE $J� .�S <br /> 2) t4ATER SERVICE TO BE PAID BEFOItE BUILDING <br /> 2ERh1IT IS ISSUED $ 2 ,'�, � — <br /> (A) TO BE D�TERMIIvED BY PLBG. INSP. f �• INCH P�a�'• �y � <br /> M£Gh� 3/. � <br /> (B) EXIST. �9r1TER SERVICE, APPL. N0. <br /> (C) APPROX. LCC7ITIO,y � �� �f � �ro>t /7� �t/gc� <br /> ,n / <br /> � _O� C.t�'h � Er �. �ne CHART S /�b <br /> 3) DRIVL�9�1Y PERi.1IT TO BE P�aID BEFORE BUILDING <br /> P�RPIIT IS ISSUED 'y'2� gT, ��p/� D/�q (TYPE) $ �°� <br /> TOTAL* $ ��• ��`-� <br /> 4} STAT[1S�SEiVER CFiARG�S: _--_--_ <br /> ROT7� lL. DISTRICT_���� r'pOTP. ;� 'JS� <br /> :I. S, W. <br /> �— JV'I'liS � SLiS:R C:;;;N:iCTION CHARGfiS: <br /> ]�AR <br /> I � - ��� ���- � � . _ TRUNK ` __ S� -- <br /> � I.ATERAL $ - <br /> i � <br /> TOTAL CO:dN�CTION CHARGE $ p , J <br /> ' � "- �a -- <br /> I �(��. , TO BE �/�i0 SEi4ER PERb1IT F�E $_�� � _ <br /> ; � ��/� To ClrrerrS' �f'�cu.v � <br /> � ��0� � Cc�TCH BASZN PER�;IT FEE $ fG po <br /> � TO /�U/�� <br /> I � '� '�''�GY?. �E�iv//T.( Tt�TAL SEIt'E22 2EIL`�f_TT F�ES $ p <br /> ' S) IdO:�'1'}ILY SI:IdER CHr1RGES : --�-��u <br /> S�I�ER CONSTRUCTION: <br /> TRUiv'Y. C /� � _ <br /> r <br /> LATERAL $__��� <br /> SBWER SLRVICC: � �y��.C��- <br /> LJy1_1.� <br /> lPP??OX. LOC�lTIOv UI' SIOF, SEh'ER OR TEE IIJ HE I•LIIN: <br /> �p'�.� /+�e af Stire � 7 � o C�_ -- <br /> --1'��7-.-�.-''�.-1n�'3?C�'�r iah r g�t�(g_�. " CHAR'1' ---�'' •.2 S_� <br /> IP1P0 CO?SPILP•,D EY: Ra�++i�v . -. r�ppv�x. .t-�k,c�v at�� DATE <br /> RI:VIEIQ: _ __ ' DATE <br /> YH'OJECTS DIVISIQ� <br /> APPROVAL: DATE <br /> Ef:GIP]��RING UL•'PlRTp7E:�1' ----- <br /> * This total must be paid before build'ng r�rmit is i.ssucd. <br />