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BUILDIAIG PcitMi ° � <br /> �.�1.0'/ �7-�--TYPE ��.t':2 <br /> ADDRESS 41Q�`'� ���G S '�'7 � U <br /> (1) BUILDING PERMIT FEE �`Z� E'O0" U' !/• 70 <br /> (q) PLAN CHECK FEE 'L�" �� <br /> (2) PLUMBING � <br /> (3) MECHANICAL �D, (7d <br /> (4) WATER SERVICE TO 8E PAID PRIOR TO BUILDING PER,MIT ISSUANCH <br /> (q) TO BE DETERMINEU BY BLDG INSPECTOR� <br /> (B) EXIST. WATER SERVICE, APPLICATION NO. — <br /> (C) APPROX. LOCATION <br /> CHART — <br /> (5) DRIVEWAY PERMIT TO BE PAID PR OR'TO�UILD�R VEWAY(TYPEj 5 � 2 � �� <br /> SUANCE 2�---FEET���- $ � !l�3. 'Z � <br /> 7) STATUS OF SEWER CHARGES: <br /> � 2�� FOOTAGE _� <br /> DISTRICT �— <br /> BOND �--- N, S, E, W <br /> NOTES <br /> SEWER CONNECTION CHARGES 3 � � p <br /> YEAR �TRUNK b �— <br /> LATERAL $ 3�jp • D� <br /> TOTAL CONNECTION CHARGES _ <br /> a� � a7$ 3�_�a <br /> SEWER PERh11T FEE ,.,_�-- <br /> CATCH BASIN PERMIT FEE p ����� <br /> TOTAL SEWER PERMIT FEES �I� aI $ _—� <br /> (7) MOI�THLY SEWER CHARGES: $ �2� <br /> TRUCK <br /> SEWER CONSTRUCTION LATERAL <br /> 5,/ C� <br /> SEWER SERVICE <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br /> CHART L� �`Z -ZS-� <br /> DATE _- <br /> INFO COMPILED BY: —_ DATE <br /> qpPROVAL: <br /> 9.1•79 <br />