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� i� � � <br /> � � , <br /> � DEPARTMEHT OF COMMUNITY DEVELOPMENT SERVICES - <br /> BUILDING PERMIT INFORMATION <br /> ADDRE55 `-5pZ ��-"'-"-'-•�"r C���� S. LU_TYPE � ��- . <br /> { (1) BUILDING PERMIf FEE �8,�7, �U $ 274` �� . <br /> 1 (A) PLAN CHECK FEE � ' ��' �� <br /> � (2) PLUMBINC ? c�). D O <br /> � (3) MECHANICAL �� � s� - <br /> � (4) WATER SERVICE TO BE PAID PRIOR TO 6UILDING PERMIT ISSUANCE �� � <br /> (A) TO BE DETERMINED BY BLDG INSP[CTOR _ �' ' INCH <br /> (B) EXIST. �VATER SERVICE, APPLICATION NO. <br /> (C) APPROX. LOCATION hTLlv�io,ta� T� F'l - t�Pti"/�1'' L <br /> �Z�_G o� .C/.lU• �'�� �CHART_,E _—� <br /> �•2-2 ,-� <br /> z <br /> 0 <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR i0 BUILDING PERMIT IS- � <br /> � SUP.KCE FEET DRIVEWAY(TYPE) $ ��`0� — m <br /> $ X/�. 3s <br /> � � — � � <br /> (7) STATUS OF SEWER CHARGES: <br /> � � DISTRICT __.FOOTAG[ `" _ <br /> 80ND o `�' <br /> N, S, E, W m o <br /> NOTES � ''m <br /> � � <br /> m <br /> .o � <br /> c <br /> � � � <br /> � -I N <br /> K <br /> T <br /> oa <br /> � � m <br /> x <br /> m «-� <br /> N <br /> or <br /> � SEWER CONNECTION CHhRGES 27�� �U m �' <br /> ��qR �3 TRUNK $ � � <br /> . m <br /> LATERAL n <br /> A <br /> TOTAL CONNECTION CHARGES $ �'��`�� -' <br /> x <br /> - n <br /> z <br /> SEWER PERMIT FEE $ <br /> �.�� � <br /> � <br /> CATCH BASIN PERMIT FEE o <br /> TOTAL SEWER PERMIT FEES $ �'�� �� `�" <br /> n <br /> m <br /> (7) MONTHLY SEWER CHARGES: <br /> SEWER CONSTRUCTION TRUCh $ <br /> LATERAL <br /> , SEWER SERVICE <br /> � APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: l /1T � ' �ag��;'� <br /> ,Q�_OK �.�F'T E E�F �I-G!i' l C'� O� GC i � d t%'.�''OX <br /> i (aP7 /�A _-- CHART �z'8-`� <br /> � <br /> INFU COMPILED BY: Di TE <br /> . <br /> APPKOVAL: D.4TE — <br /> 1 <br /> � <br /> 1 <br /> 9�1�79 <br /> .� <br /> ! <br />