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; <br /> BUILDING PERMIT INFORMATIOW <br /> ADDRE55 ��'. �� �- � �l(9L 1'�5�-�'��� Tl'PE <br /> (1) oUILDING PERh11T FEE S ���� �vJ <br /> (A) PLAN CHECK fEF f��.l �"7 <br /> (2) PLUMBING (� LV <br /> (3) MECNANICnL ��n '� <br /> (4J WATER SERVICE TO BE PAI'� FR:I;F i0 [3UILDING PERr11T ISSUANCE l���O� _ <br /> (A) TO BE DETERM!NED :IY DLC):, 1NSPECTOR `Si�I �� INCH <br /> (B) EXIST WATE%�. SERVICE, APPLICATION NO. <br /> (C) APPROX. LOCATION _ <br /> CHnRT <br /> (5) DRIVE�NAY PERh11T TO 8E PAID PRIOR TO BUILDING PERMIT IS- � <br /> SUANCE FEET _ DRIVEWAY(TYPE) b �C) <br /> b <br /> (7) STATUS OF SEWFR CHARGES. <br /> BOND � DISTRICT FOOTAGE <br /> N, S. E, W <br /> NOTES <br /> ll"ll- � J <br /> �r� ���-1 °=` . <br /> SEWER CONNECTION CHARGES <br /> YEAR TRUNK 5 ���� <br /> LATERAL <br /> 70TAL CONNECTION CHARGES b <br /> CEWER PERMIT FEE $ �-x � <br /> CATCH BASIN PERMIT FEE <br /> TOTAL SEWER PERMIT FEES $ ��-�— <br /> (7) MONTHLY S[WER CHARGES: <br /> SEWER CONSTRUCTION TRUCK � <br /> LATERAL <br /> SEWER SERVICE <br /> APPROX LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br /> CHART <br /> INFOCOMPILCD BY: DATE <br /> APPROVAL: DATE <br /> ,;a, <br />