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<br />� ADDRESS �i
<br />��i �•!� ,(�� f" � t ���C:�
<br />`��/�
<br />TION �
<br />� ���
<br />f i
<br />, . ,. _. i ;� -_ �7 _
<br />� TYPE OF' BUILDING ���-'. %�`F'K DATE � �� ��
<br />1) RUILilING PERMIT FEE 4-a, "l��'� �'"� � ��� �U �
<br />(A) PLAN CHEGK FEE � �� `�U
<br />2) WATER SERVICE TO BE PAID BEFORE BUILDING
<br />PERMIT IS ISSUED
<br />(A) TO BE DETERMINED BY PLBG. INSP. •',/=,` INCH
<br />(B) EXIST. WATER SERVICE, APPL. NO.
<br />(C) LOCATION �i /yfi��iV Lii',lri•�) .�:'; ,��',,.- ,,(�' �.;:�;:- .�, �
<br />�•15i CI - l.�J G�iti�_ CHART J-i r/
<br />3) DRIVE�VAY Pr:ItMIT TO BE PAID BEE ,IRE BUILDING
<br />PERMIT IS ISSJ�D FT. D/W (TYPE)
<br />,=�1'i �:c' ��-/' /ILC�:c.
<br />TOTAL��
<br />' 4) STATUS OF SE�'.'ER CI-IARGES: , ,
<br />BOND -;�- DI5TRICT o:� FOOTAGE "_�.,��
<br />N. S. .,,E�rW:
<br />LANP.SCAPE NOTES SEWER CONNECTION CHARGES:
<br />TFUNK
<br />%�� i„ ,� t'ii+,�.� _S ,- .: %i%
<br />(�, r� // V �` ��� ��
<br />$ ' �`�!-�' �� C,
<br />q --
<br />$ 4-0�• �'�
<br />r� , �
<br />$ �,'_''_ �,
<br />TE A� -7 $ i�c���.CJC)
<br />TOTAL CO��ECTICdN ��HA�GE $ %�CvJ � C� D
<br />SEWER PERMIT FEE $ .�C7 •(1 �'
<br />CATCH BASIN PERMIT FEE -,��` $
<br />TOTAi SEWER PERMIT FEES $_.
<br />5) MONTHLY S�WER CHARGES:
<br />SEWER CONSTRUCTION:
<br />SEWER SERVICE:
<br />TRUNK $ -
<br />LATERAL $ ="�� �� 1
<br />LOCATI(UN OF SIDE SEWER OR TEE IN THE MAIN:
<br />�. ,.� >; „
<br />; ��e�x��.�sr,r� � � lU��.i; �-r;., /' '�,
<br />- .
<br />� . � /i�i t
<br />CHART �'� -�7
<br />. ,
<br />, ,
<br />�' �� z�.
<br />' ::-:< i:�>' rt ° _
<br />INFO COMPILED BY:
<br />REVIEW:
<br />� ,
<br />APPROVAL:
<br />ENGINE�RING D�PARTM�NT
<br />E
<br />#This total must be paid before building permit is issued.
<br />�.-;,,
<br />$l��`��r il i�d=,
<br />,�:: rrt ; � .�—
<br />iii .', �- � '`'�
<br />DATE
<br />�, ,,.. �
<br />, ) .�;,.-V.
<br />- !�.- % �
<br />DATE �-�`'7S-
<br />DATE
<br />
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