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DEPAIITMENT OF COMMUNITI ?VELOPMFNT SERVICES <br /> BUILDING PERMIT INFOR (NATtJN <br /> ADDRESS ..�`!1 � :�t, �'�'"'e ' '�� TYPE .�j r " -- <br /> (1) BUILDING PERMIT FEE yI� 0 00 � <br /> _ S .�y� ,�O <br /> (A) PLAN CHECK FEE ����� — <br /> � � � <br /> (2) PLUMBIIVG �s <br /> (3) MECNANICAL -�� � <br /> (4J WATI:R SERVICE TO dE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br /> (A) 'f0 BE DETERMINED BY BLDG INSPECTOR��NCH <br /> (B) EXIST. WATER SERVICE, APPLICATION NO. <br /> (C1 APPROX. LOCATION _ <br /> CHART - <br /> (5) DRIVEWAY PERMIT TO BE P!�!D PRIOR TO BUILDING PERh11T 15- ��G37 �O o� <br /> SUANCE FEET DRIVEWAY(TYPE) b <br /> b <br /> (7) STATUS OF SEW CHARGES: <br /> BOND _�DISTRICT _FOOTAGE <br /> N, 5, E, W <br /> NOTES <br /> SE�NER CONNECTION CHARGE� �30 � <br /> YE�R _�--TRUNK 5 <br /> LATf:RAL ��,�,� �9"3 334�— <br /> TOT,4L CONNECTION CHARGES � <br /> � <br /> SEWEk PERMIT FEE $ `JD <br /> CATCH BASIN PERMIT FEE � �'7�B O <br /> TOTAL SEWER PERMIT FEES $ __ <br /> (7) MONTN� Y SEWCR CHARGES: <br /> SEWER CONSTRUCTION TRUCK b <br /> LATERAL <br /> SEWEi2 S�RVICE <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br /> ' CHART � �-�' `� � y <br /> INFO COh1P;LED BY: DATE -- <br /> � DATE <br /> APPROVAL: <br /> 91 79 <br />