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liNGINI.ERi�:G DEPARTPIGD:1' <br /> � ., /�/ �1`,, ��UILDING PERFIIT 1NFORMATIO[1 <br /> �(-7 — <br /> 11DGRESS�l�1�.f�� �- _� /� I l� � 'i'il':: L G�L4.-L� � <br /> 1) BUILDING PERMIT FEE �.Q �� �� '� $ ZC' �' c�— <br /> (A) PL1�N CIiECK FEE $ / .. S'� <br /> ?.) C:,`,'P�R SERVICE TO BE PAID BEFORE IIUILDING ;, ��.�, <br /> � 1'�RMIT IS ISSllED � . � S �� � `� — <br /> i % <br /> (�l) TO BE DETBRNINED BY PLDG. INSP. '�� INCI3 <br /> (B) EXIST. 3�l/ ? [9ATBR SERVICE, APPL. N0. � i ��_': �- <br /> (C) APPROX. LOCATION ,�. �I �f�Ll/, 1 , 2y �/lJ d r � � <br /> ��eV�eUe � � � � �Z� � ��Q/,�J J �rL CHART 5 / 86 <br /> 2�,�� <br /> 3) DRIVEWAY PERMIT TO PAID IIEFORE BUILDING crJ <br /> PTRMIT IS ISSU�D�� FT. � � D/W (TYPE) $�'� <br /> TOTAL* $ <br /> 9) STATUS OF EWER CHARGES: <br /> GOND c DISTRICT �� FOOTAGE � o2v <<�'Ti• ���x, <br /> N, S E, W. <br /> �,� 3 2'f /�{ 3 <br /> NOTES f�SESVER CONNLCTION CHARGES: <br /> S GU7�/L /(CCT 3 �.�' I 4 3 -�o YEAR 7�n TRUNK $f�, ��C! <br /> � r 20'– 75 � _ �{ 5'CD�r-F,� �c�� ��T�s/�+� s/� 7, �S— <br /> ��� I� �G� ? — r, 1 � , TOT L ONNEC" .ODQ C ARGE S3 D�, G 5 <br /> ri �... <br /> SEWER PERMIT FEE $�[j , OZ) <br /> CATCH BASIN PERMIT FEFP���a $ <br /> iTOTAL SEWER PERMIT F�ES $ _ _ <br /> ��� P;�;]TIdLY SEWPR CH��RGES: <br /> SEY:EP, COi�S'PP,liCTIO;d: p <br /> TRUNR $ p L' <br /> LATERAL $ .�j. � C� <br /> Slil9GP. S�RVIC�: $�,F'T�/L�n <br /> i � <br /> ;�i�i'ROX. LOCATION OF S�D� SEWER OR TEE IN THE IN: , ^ o �. <br /> c.+J_S�l-��sre– W S �J e 1� ec.� � e e L <br /> y (o HART G- 7— 2$ — S <br /> �;IPn COMPSLED BY: . DATE �—�/-7(-� <br /> ;Ci;A� I LN: DATE— --- <br /> PRO/JfECTS DIVISION <br /> ,',i'?'1: ��;.�:1�. �-���%��^_%�-L� --------- D,1'I'P_CU �7/7`----- <br /> y 1,. <br /> �:�+1,�1.1,�21.`�Ci �Ll�t3:��l�i��1_.��1' <br /> `� �iu :s Y_ot��l Tusi_ h., nni�3 br�torc h�iil�:i:��J . ^t -iit is . _.,.���1. <br />