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� _/' <br /> BUILDING PEItMIT INFOF�iyIATiON <br /> . i v c✓ nu 7� A-�/�- — 7YPE!J'i.v4c6 {�MiaY �t r.+�vrr <br /> ADDRE55 .—.�=-'�- � �Q¢,Sa <br /> (1) BUILDING ^ERMIT FEE � q�.�' � Ptl H ��7� � <br /> (A) PLAN CHECK FEE �D � <br /> (2? PLUM8ING 35.5"� <br /> (3J MECHANICAL B <br /> (4J WATER SERVICE TO BE FAID PRIOR TO BUILDING PERMIT ISSUANCE <br /> (A) TO BE DETERMINED BY BLDG INSPECTOR INCH <br /> (B) EXIST. WATER SERVICE, APPLICATION NO. <br /> (C) APPROX. LOCATION <br /> CHART <br /> (5) DRIVEWAY PERMIT TO 8E PAID PRIOR TO BUIL�DRIVEWAY(TYPE) S 2�'�� <br /> SUANCE _---FEET <br /> b — <br /> (7) 5"TATUS OF SEWER CHARGES: <br /> f:IOND �--DISTF T FOOTAGE <br /> N, S, E, W <br /> NOTES <br /> ��1iw G/Ttur-y � <br /> O,P„p !!7/$S <br /> �IZO � Z�.Q� <br /> SEWER CONNECTION CHARGES <br /> YEAR 87 TRUNK S <br /> S�-. <br /> LATERAL � �n�-81.- <br /> TOTAL CONNECTION CHARGES � <br /> � .�0•�t> <br /> SEWER FERMIT FEE r <br /> CATCH BASIN PERMIT FEE �0�� <br /> TOTAL SEWER PERMII rEES b _ <br /> (7) MONTHLY SEWER CHARGES: TRUCK b <br /> SEWER CUNSTRUCTION <br /> LATERAL <br /> SEWER SERVICE <br /> �`,PPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br /> _ CHART <br /> DATE <br /> INFO COMPILED BY: <br /> DATE s-- <br /> APPROVAL: —.---- <br /> s e4 <br />