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, � � � . _ <br /> � . , <br /> . _ . � - <br /> BUILDING PERMIT INFORMATION <br /> , , , _ � <br /> l � � — � �"� . , � � /_ . <br /> ADDRESS - ' � � <br /> i DATE . ' <br /> TYPE OF BUILDING - � ' - <br /> ��t.��CL' <br /> 1) BiJILDING PERMIT FEE � 7']� Q ,�.t�• �—U— <br /> (A) PLAN CHECK FEr <br /> Z� PERMIT SRISSUED� BE PAID BEFOR� BUILDING �—_- - -_�- <br /> (A) TO BE DETERMINED BY PLBG. INSP. /-> � ` "- ' INCH <br /> (B) EXIST. 3� �yATER SERVICE, Al'PL. NO. <br /> (C) LOCATION <br /> CHART <br /> ;-• ���: � <br /> 3) DRIVL�'�AY PERMIT TO BF PAID BEFORE I3llU���TYPE) n , � ' � <br /> PERMIT IS ISSrTED ' -' FT•f'i `'l'�;'' % �G���I(r7 � � � �� <br /> TO AL� ^� <br /> 4) STATUS OF SEWER CF-IARGES: FOOTAGE <br /> BOND DISTRICT — N, S, E, W. <br /> LANDSCAPE NOTES SE'�VER CONNECTION CHARGES: , <br /> TRUNK $ � ' <br /> �/ ,� ��'�1 <br /> �� <br /> �y/� „�.�,�- � �� l - „'�,� LATERAL �-� $ 1 -P ��-- <br /> - �il � . <br /> �Iu(�,5.� I��O � (.Ui`'!/�� �'� �-�� TOTAL CONNEGTION GHARGE $� <br /> �' ` e � <br /> ���' � �'(�t_',!_/.� p��T �i,_�' �/i�/. / SEWER PERMIT FEE $ '; �'. � ., <br /> CATGH BASIN PERMIT FEE $ � <br /> TOTAL SEWER PERMIT FE �$_. i/ ' ' <br /> 5) MONTHLY SEWER CHARGES: ��'c �G�'��S <br /> SEWER CONSTRUCTION: TRUNK $ �� " � <br /> LAT�FtAL � ' � ' ' � <br /> � \�, `. C..' <br /> SEW�� SERVICE: <br /> LOCATION OI' SIDE SEJ�'�R OR TEE IN THE MAIN: CHART %yi " Ii � ; _ <br /> �. <br /> - /i�.' . .; i . %�'_' - ',y �= ,'" <br /> �. . ;_:� . <br /> � � � � <br /> �.�i' , �� : � ;' - - , , <br /> , , _ � , . /r% , -� . <br /> r. . DA T E�,= <br /> INI'O COMPILED �Y: 'i �i , - � — <br /> l4 �- _ DA T E� , <br /> REVIEW: `�" •r f,,FFIC DIVISION � <br /> DATE �Z�J� <br /> APPROVAL: GI �ERIN DEPARTMEN <br /> �This total must Ue paid 'ueforc building permit is issued. <br /> P <br />