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ENGINEERING DEPARTt4ENT <br /> - SUILDING PERMIT INFORIMTION <br /> ADDRESS �CDZ� �.J2o I�� 5.� . 1 TP�C,� '1�11 TYPE �-,�=�L <br /> 1) BUILDING PERMIT FEE S � � �l <br /> �.oc�.��n . ' I .�C�• <br /> (A) PLAN CHECK PER S ��� C90 <br /> 2) Y7AiER SERVICE TO IIE PAID BEFORE BUILDING ' <br /> PERMIT IS ISSUED 5 2��� �� <br /> '�, a P,4 , �3 -� <br /> (A) TO BE DETERIdINED BY PLBGe INSP. TNCH � R=*'� � �'�'o <br /> (B) EXIST. WATER SERVICE, APPL. N0. . <br /> . (C) APPROX� LOCATION �GT l�U F�/' w r`'�/'' L���� _ <br /> �G, .�EL� �'{ G� Co' ti • Z _ CHART J-'G I� . <br /> 3) D3IVESaAY PERMIT TO BE PAID BEFORE IIUZLDING <br /> PERtifIT IS ISSUED � FT. �1��-'PflAG7 D/W (TYPE) $ ��Z''J �� <br /> TOTAL* $ <br /> 4) S:nTUS OF SE�+IER CHARGES: <br /> &O::D 1� DISTRICT ��� FOOTAGE <br /> N, S, £, W. <br /> NOTES SEY7ER C0:INECTZON CHARGES: � <br /> YEAR �� TRUNK S �L�L�' G <br /> , � �, , . .._.�- , - pc, 'L(O; � oo <br /> _. I,ATERAL S <br /> TOTAI, CONNECTION CHARGE $ 4"�J` �� <br /> • SEWER PERP7IT FE� S �'-�n G� <br /> CATCH BASIN PERb1Ix FEE S <br /> TOTAI. SEWER PERPSIT FEES S ��, � <br /> 5) ::J:��::LY SE!dER CHiiRGES: <br /> �EWER CONSTRUCTION: <br /> TRUNK $ <br /> LATERI,L S <br /> SEW7ER SERVICE: $ <br /> APPRJ\. LOCIITION OF SIDE SES�R OR TEE IN THE MAINa f=i �� G �,vL � � <br /> �r-> Q�G STciN t1V/�i1mK !' � !� �� �=� // ili%f',Cc�K 8� 7�c-3:1� _ <br /> � f�2oP L��vG CH11RT � - I L;- Z£3- � <br /> INFO :.J>:PILEA SY: DATE <br /> REVIE�i: DATE _ <br /> � PROJ�CTS DIVISION <br /> AP P R01'�L: DATE <br /> ENGINCERING D::PARTM�NT , <br />