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1 <br />DEM�TMENT OF COMMUNITY DEVELO�MENT SERVICFS <br />BUILDING PERMIT INFORMATION <br />ADDRESS lC�S �Z Q-TN QuC 5. � TYPE ��ti4t�E ���c.r Lt.3 <br />(1) BUILDING PERMIT FEE�� DOO• °-� 5 25Co• ��V <br />(A) PLAN CHECK FEE 1�- SS I7u� <br />(2) PLUMBING <br />(3) MECHANICAL <br />(4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br />(AJ TO f3E DETERMINED BY BLDG INSPECTOR 3��.INCH <br />(B) EXIST. WATER SERVICE, APPLICATION NO. <br />(C) nPPROX.I.00A'1'ION <br />CHART <br />(5) DRIVEWAY PERMIT TO E3E f'AID PRIOR TO [3UILDING PEftMIT IS- <br />SUANCE <br />FEET <br />p1 S1�TUS OF SEWfR CHARGES: <br />BOND � DISTRICT <br />NOTES <br />0 <br />5�.� ��. �_ <br />b2o 6�7!—SS' <br />Sr.tiLccL� ��.5. <br />dl?.� �r��•� <br />�-w�t2 4- c� <br />� 5 � <br />DRIVEWAY(TYPE) S <br />• b <br />FOOTAGE <br />N, S, E, W <br />SEWER CONNECTION CHARGES <br />YEAR � � TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGES � <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />(7) MONTHLY SEWER CHA".GES: <br />SEWER CONSTRUCTION <br />S[WER SERVICE <br />/8-� <br />22•5v <br />Cem•OU <br />20.DC� <br />g 33� •� <br />$ 330•._ <br />� 3D• � <br />TRUCK b <br />LATERAL <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />INFO COMPILED f3Y: <br />APPROVAL: <br />5 D4 <br />CHART <br />DATE <br />DATE <br />