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DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES <br />BtJI�.DING PERMIT INFORMATION <br />ADDRESS TYPE _ _ <br />(1) BUILDING PERMIT FEE $ — <br />(A) PLAN CHECK FEE — <br />(2) PLUMBINC — <br />(3) MECHANICAL — <br />(4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE _ <br />(A) TO BE DETER.�IINED BY BLDG INSPECTOR INCH <br />(B) EXIST. ___— �NATER SERVICE, APPLICATION NO. <br />(C) APPROX. LCCATION _ <br />CHARI' <br />(5) DRIVEWAY PERMIT Tc� 8E PAID PRIOR TO RUILDING PERMIT IS- <br />SU.ANCE _._FEET DRIVEWAY(TYPE) S <br />S <br />(7) STATUS OF SEWEK CHARG[S: <br />BOND DISTRICT <br />NOTES <br />FOOTAGE _-- <br />N, 5, E, W <br />SEWFR 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 CHARGES: <br />SEWER CONSTRUCTION <br />S <br />S <br />S <br />S <br />TRUCK $ <br />L�TERAI. <br />SEWER SERVICE <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE M'�IN: <br />INFO COP�PILED BY: <br />APPROVAL: <br />41�79 <br />CHART <br />_ DATE <br />— DAfE <br />� <br />