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IIUILDING PLR�-1IT 1NFOR�QATION <br /> ADDRESS f��� .� (�/ ['C �� �lfJ �� � r,�✓� � G�� -- <br /> i.,- � <br /> TYPE OF BUILDIATG _-'. � ./L • DATE �� -- -� l, � <br /> 1) BUILDIi�'G PEP.M�T I'EE $ ��� � ' ' <br /> (A) PLAIJ CHECI{ FE;�. $ �Ds�' S�r' <br /> 2j �VATER SERVICE TO BE PA1D BEr'ORE BUILDING <br /> PERMIT IS ISSUED 5 ' ,'. 7� . . ' <br /> �(A�O IIE DETERMINED BY PLBG. TNSP. INCH <br /> (B) EXIST. WATER SERVICE, APPL�. NO. <br /> , ,, �-, <br /> (C) LOCATIUN E�'ti� � !'�(i l� 'e=J% S ; ,_ , � ' . . <br /> ,ji'G�� �, < r�=�;f,,-_ /}�. ���%C CHART �� � � C . <br /> �) DRIVE�1'AY YERIIIT TO I3E YAID BEFORE BUTLDING � _ <br /> PERMIT IS ISu�JED ��' 'i_ F7. �;^� i�,(-'���F_il;14� (�!'Y�'E) $ / _ . C c�� <br /> ' TOTAL $ �� � i ('' �' <br /> 4) STATUS OF SE�VER CHARGES; �Vf,(��r;`� y %���� <br /> BOND DISTRICT FOOTAG� <br /> N, S, E, 1V. <br /> LANLSCAPE NOT�S SEINER GONNECTION CHARGES: <br /> TRUNK $ <br /> LATERAL $_, _ <br /> TOTAL CONNECTION CHARGE $ — <br /> SLWER PERbiIT FEE � J(!, (� r"% <br /> CATCH BASIN PERMIT FE� �a —' -- <br /> TOTAL SEWER PERD4IT FEES 5 � i �. � <br /> 5) MONTHL's SE\V�R CHARGES: • <br /> SEIVER CONSTRUCTION: <br /> TRUNK $ <br /> � LATT•.RAL � --- <br /> SEtiVER SERVICE: $ �' ` � � ' <br /> LOCATION OF SIDE SEWER Olt T�E IN THE Iv1AIN: CHART /� ' �� �i% y <br /> / /�'. !i/ii� ,iN ';'�. ii: �. , , .,�� L: i�.'/'n�`i�, �/ ' i <br /> ��/. /��% , /I/ . <br /> � s <br /> INFO COMPILED BY : �' -.= .�/,�� c/ ( . _ DATE � -�,;�,;' �'.S <br /> REVIEW: DATE , <br /> ;� TRAFFIC DIVISION <br /> � � `/�� <br /> APPROVAL: C Q�r � -, ,-�T'e:.--lc �-c DATE Z-�2 �� �.�- <br /> �, ENGI�EERING DEPAI2TMENT % <br /> This total must be paid before Uuilding pezinit is issued. <br />