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ADDRESS <br />TYPE OF BUILDING <br />BUILDING PEFMIT INFGRMATION <br />-5 V I k G l,cJ/ /-� / U G, <br />5.F:2- <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />DATE I " Cs -%S <br />� nl .:2, U u <br />$ `t (n • �' � _ <br />2) �VATER SEhVICE TO BE PAID BEFORE BUILDING <br />PERIv1IT IS ISSUED <br />(A) TO BE DETFRMINED bY PLIIG. INSP. /�/ INCH <br />(B) E_{IST.��_ WATER SERVICE, APPL. N0.��7 / <br />(C) LOCATION S� %t> • �(�GD�i�%7 C����ZNF2 <br />CHART -7Q <br />31 DRIVL\4'AY PERM:T TO BE PAID BEFORE BUILDING <br />PERMIT IS ISS�JED -'�rT. ^— D/�V (TYPE) <br />TOTAL� <br />4) STATUS OF SEWER CHARGES: ^(0�(-� �(�{,�i <br />BGND DISTRIGT -�--- FOOTAGE -i <br />N, S, E, lV. <br />LA1VLJl�HYI. 1\V ALA <br />iE\YER COI�'NECTIOI�T CHARGES: <br />TRUNK <br />UF.11Y�i;�.l�J <br />TOTAL CONNECTION CHARGE <br />iEWER PERMIT I'EE <br />CATCH IIASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />$ i�� �UC� <br />q,�._-` �,_ <br />Y � <br />� l,a 3. C� <% <br />5) MONTHLY SEWER CHARGES: , <br />SEWER CONSTRUCTION: <br />TRUNK $ <br />LATERAL ^� --� <br />SEWER SERVICE: $ �s � O <br />LOCATION OF SIDE SEWER OR TEE IN THE MAIN: CHART L-�2o -a�� <br />CAfP�D ,ar ��vsr PRoO�,�'ry ��v� ,I�pdP',�r�2a�c ��n' sa ��' <br />„� <br />M. N . � � a3'�� ,�1 �02� � r�'�r? (Q'���U.�,` � ��'���� � <br />INFO COMPILED DY: <br />REVIEW: <br />APPROVAL: <br />r �i <br />>�=This total must bc paid Uefore building permit is issued. <br />�.n►��o� <br />DATF /- l-'�.�� <br />DATE �-U �7J <br />