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• DEIARTMENT Oi COMMUNITY AEVELOIMENT SERVICES <br /> BUILDING PER�IAIT INFORMATION <br /> ADDRESS ���� ����� ��' � Tl'PE <br /> (1) BUILDING PERMIT FEE � ! � �•2 � <br /> � , <br /> (A) PLAN CHECK FEE �1�1�-� <br /> (2) PLUMRING � <br /> rX � <br /> (3) MECHANICAL � <br /> =�"—'-�� <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE GO � <br /> (A) TO BE DETERMINED BY BLDG INSPECTOR 3,i INCH <br /> (B) EXIST. WATER SERVICE, APPLICATION NO. <br /> (C) APPROX. LOCATION <br /> �CHART <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- o� <br /> SUANCE FEET DRIVEWAY(TYPE) S _— ��0 <br /> .,. <br /> E <br /> (7) STATUS OF SEW�CHARGES: <br /> BOND � DISTRiCT FOOTAGE <br /> , � N, 5, E, W <br /> NOTES <br /> SEWER CONNECTION CHARCES o� <br /> YEAR TRUNK 5 � �� <br /> LATERAL � <br /> TOTAL CONNECTION CHARGES 3 -�3 � <br /> o` <br /> SEWER PERMIT FEE 5 •��� — <br /> CATCH BASIN PERMIT FEE <br /> TOTAL SEWER PERMIT FEES S -2� � <br /> (7) MONTHLY SEWER CHARGES: / <br /> SEWER CONSTRUCTION TRUCK b <br /> LATERAL <br /> SEWER 5ERVICE <br /> APPRO)(. LOCATION OF S1�7E SEWER OR TEE IN THE MAIN: <br /> CHART /�T� � ''1'�-� <br /> INFO COh1PILED BY: DATE <br /> APPROVAL: DATE <br /> 5•B4 <br />