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-, <br /> , <br /> DEPAIITMENT OF tOMMUNITY DEVEIOPM&NT SERVILES <br /> BUILDING PERMIT INFORMATION <br /> ADDRESS ` `f'�� % '�-jd L�/�" �c� TYPE ��'�2 Sb <br /> O 3 2 <br /> (11 BUILDING PERMIT FEE I�I�D� � <br /> (A) PL,4N CHECK FEE �D,D� <br /> (2) PLUMBING ,/f/L �—� <br /> (3) MECHANICAL ��,Q� <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDING P�I7 ISSU INCH <br /> (!�) TO BE DETERNi1NED [lY BLDG INSPtCTOR � <br /> (R) EXIST. WATER SERVICE, APPLICATIO NO. <br /> (C) APPROX. LOCATION <br /> _ <br /> 0 <br /> �--1 <br /> r-� <br /> CHART rr'„ <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDRIVEWAY(TYPE1 S .—!G �'0d <br /> SUANCE _-----FEET '' " <br /> • � �n i <br /> v <br /> m <br /> co <br /> (7) STATUS Of SEWER CfiARGES: '"�n <br /> BOND � DISTRICT FOOTAGE • 0 3 <br /> N, S, E, W i -z, <br /> m <br /> NOTES Q z <br /> a -+ <br /> rs <br /> .... <br /> -�v� <br /> < <br /> � <br /> O p <br /> �7 D <br /> -� fT� <br /> 2 <br /> m �- <br /> N <br /> � <br /> or <br /> nm <br /> c v+ <br /> 3 N <br /> m <br /> z c-> <br /> -i r <br /> � . m <br /> SEWER CONIJECTION CHARGES 3�� � <br /> YEAR ,�S--TRUNK f = <br /> -- n <br /> LATERAL - 3���� • � <br /> TOTAL CONNECTION CHARGES b =__ _ <br /> � <br /> z <br /> 3�•Q�._ ` <br /> SEWER PERMIT FEE $ • � <br /> n <br /> C/.TCH BASIN PER�11T FEE ----- `� <br /> TOTAL SEWER PERMIT FEES $ ��-�— <br /> (7) M,ONThiLY SEWER CHARGES: TRUCK $ <br /> SEWER CONSTRUCTION <br /> LATERAL <br /> SEWER SERVICE <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: — <br /> CHART .�---- <br /> DATE <br /> INFO COMPILED BY: DATE <br /> AFPROVAL: <br /> 5 84 <br />