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BUILDING PERIvIIT INP'OP.MATION <br /> ,DDRESS �Q � � /�-�vi��l/j�L�J JLC�Q <br /> TYPE OF' BUILDING .� , /`� � DATE a�`���- 7J <br /> 1) BUILDIIVG PERMIT FEE $ / / j, 5`Z'j <br /> (A) PLAN CHECK FEE $ �j, ]S` <br /> 2) titiATER SERVICE TO BE PAID BEFORE BUILDING / <br /> PERMIT IS ISSU�D g 4�U• d�) <br /> (A) TO BE DETER�IATED BY PLBG. IPiSP.�_ INCH <br /> (B) EXIST. WATER SERVICE, APPL. NO, <br /> (C) LOCATION S W , P,2UY� CjUE"'NG,P , <br /> CHART S'd�,�, �] <br /> 3) DRIV�'WAY PERMIT TO BE PAID BEFORE BUILD=NG <br /> PERMIT IS ISS:JED a' FT. C%^iti�',�i�Q D/\V ('TYPE) $ l a•S O <br /> � TOTA'.;: �y ,�� ( � _� <br /> 4) STATUS OF SEWER CHARGE5: <br /> BOND �� DISTRICT � FOOTAGE <br /> N, S, E, W. <br /> . \. <br /> LANDSCAPE NOTES SE\VER CONNECTION CHAFGES; ` ('•'l�L', <br /> TRUNK �—� $ �pOi CJ Cj�,� <br /> LATERAL ; - <br /> TOTAL CONNECTION CHARGE Q ���. D� ' <br /> SEWER PERMIT FEE $ SCJ, U d <br /> CATCH BASIN PERI�4IT FEE ' $ —� <br /> TOTAL F.F.'+/7,R PFRMIT FEES $ _ J�U� v C7\` ; <br /> 5) MONTHLY SEWER CHARGES: , `� <br /> SEWER GONSTRUCTION: r,'� <br /> TRUNK $ �. lS <br /> � LATERAL $ �—� <br /> SEWER SERVIGE: $ �� SL) <br /> LOCATION OF SIDE SEWER OR TEE IN THE MAIN: CHART .(�/— �-�� �- <br /> L.</�fi:L //VPU �l SO. `�D� �iN/G' 1,��,�'{�41 � �% l (1� /1'1.��. ��. <br /> �v' r F d d'/ ,�i ,� � '�� � !' � , 'r7 ,�'r � <br /> INFO COMPILED BY: DATE <�,���</•]� <br /> REVIEW: �" �<<<,� _� ' � DATE .� /j J1l <br /> � /j5 TRAFFIC �IVISION <br /> (� ��� ✓� ��� ` <br /> APPr�OVAL? r--�J�'iLL�� Y' �/��Jl�.__ <br /> �_ EN IIv ERIN D PARTMENT DATE J <br /> '�This total must be paid before building permit is issued. <br />