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i <br /> - ) ) <br /> � DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICE5 <br /> BUILDING PERMIT INFORMATION <br /> ADC�RE55 -��� / �r,-�- l�'�w, �J l./.•_ TYPE ✓'� � �� <br /> s�, <br /> (1) BUILDING i'ERMIT FEE �/j, 0 �' 0 �' S '1 ''r� � <br /> (A) PLAN CHECK FEE ' <br /> �° � <br /> (Z) PLUMRING ''2O <br /> f�' -° <br /> (31 M�CHANICAL �, <br /> (41 WATER SERVICE TO 8E PAID PRIOf. TO BUILDING PERMIT ISSUANCE _--�0 <br /> � l.� .. <br /> (Ai TO BE DETERMINI:D BY BLDG INSPECTOR �� _ INCH <br /> (B) EXIST. WATER SERVICE. APPLICATION NO. <br /> (C) .APPROX. LOCATION <br /> CHART — <br /> (5) DRIVEWAY PERMIT TO CE PAID PRIOR TO BUILDING PERMIT IS- �� <br /> SUANCE �S FEET ��'y�-��� �RIVEWAY(T`'PE) S �� � <br /> S 3-���� <br /> (7) STATU� OF SEWER CHARGES: <br /> BOND �DISTRICT _(rJGTAGE <br /> N, S, E, W <br /> NOTES <br /> SEWER CONNECTION CHARGES � <br /> � <br /> YEAR __ TRUNK S _-�-��- --- <br /> LATERnL --.�-- <br /> TUTAL CONNF_CTION CHARGES � .__-=��- __ <br /> o� <br /> SEWER PERMIT fEE g — 30 `� <br /> CATCH BASIN PERMIT FEC 3---f---- <br /> TOTAL SEWER PERMYT I�EES $ — � <br /> (7) MONTHLY SEWER CHARGES: % <br /> S � <br /> SEWER C(�`:SiRUCT�ON TRUCK b -= � �'� <br /> LATERAL -- <br /> SEWER SERVICE l'. SG <br /> __ AF'PROX. LOCATION OF SIDF SEWER OR TEE IN THF. MAIN: — <br /> CHART� �•z � � �-� <br /> ; INFOCOMPI:EDBY: DATE <br /> APPROVAL: DAT[ <br /> a,.-o <br />