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PUIt C I'1'Y USti 0�]f,Y � <br /> L•'NGTP7GP;RING Ai�D COi1P1UP7I'PY 5L•'RVIG;S <br /> BUILDING P1iRI�tIT INI'OR1•11\TION <br /> AUDRESS %�� :' / ;�:,-; --<;' TYPE CU;�; ,;; . <br /> 1) L'UILDING PER:7IT FEE $ � �,� ,, , <br /> (A) PLnt� CIIECK PEE $ ; � y: �� <br /> 2) PLUMBING ' S �`7 , ;' <br /> 3) M�CH71NIC1\L $ c�i� ;i� <br /> 4) i'�ATSR SliRVICE TO II2i PAID IIEPORG IIUILDING <br /> P�RMIT IS issorn ' $ � �, , <br /> (n) TO, IIE DETERMIVED 9Y PLIIG. INSP. �_INCH <br /> (Rl EXIST. T7ATER S�RVICE, APnL. N0. <br /> (C) APPROX. LOCATIOtd �� �'7 /�✓I'i<J� /C��`"' r/./ , ,' r_' <br /> i",- •� i iv'� CEIART �V- 3 v <br /> 5) DBIVE[9AY PliI2P1IT TO BE PAID BEPORE llU2LDING <br /> FERti1IT IS ISSUED �. S I'T. C,aiuC D/{•7 (TYPE) S �-L S_' <br /> G) STAiUS OI' SEWER CHARGES: TOTAL $ '�',"� �' � <br /> IIOND DZSTRICT FOOT7IGE <br /> N� Sr E. 1�1. <br /> NOTES � SEWFR CONNliCTION CFIAR,GS <br /> YEnR TRl1V:; $ <br /> LATERIIL $ <br /> TOT71L CONN�CTIOid CIi1�RGR$ <br /> S£•.��;ER Pr12�1IT FEE S �d� � v <br /> CATCII 9ASIN PL•'RP1IT PEE $ /� d`J <br /> TOT11I� SEI•'P•.R nERtAIT F�ES$ y � ' � <br /> 7) "fON'PNLY SE[•ICR C11ARG�S: <br /> SE?VER CONSTRUCTIOPI: TRUNK $ _—.- <br /> LnTPR1\L $ <br /> SE�aPR SliRVICE S f✓I�� <br /> APYI:OX. LOCi1TI0N OF SIDI: SF.WER OR TEL IN TLB i.IAI�: (O� �/�.�j,v�,�/ � 0� <br /> �_� <br /> �u.�Y ��� " �i�izoK _.`�_r-- ,- r�1 rv- h.��-� � a�rr�x �F; <br /> �1.���' C1111RT 5 - � �- 2-� - � <br /> II9P0 CQhiPII,ED BY: DATP <br /> APPROVAL�: DA'1'1: <br /> Y <br />