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ADDRESS <br />TYPE OF BUILDING_ffE,4-/ <br />(1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />(2) WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />DATE�� <br />(A) TO BE DETERMINED BY PLBG. INSP. INCH <br />(B) EXISTING-5 / INCH WATER SERVICE <br />APPLICATION NO. <br />(3) DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUEDa7 as FT. oni'O r �D/W (TYPE) <br />TOTAL <br />(4) STATUS OF SEWER CHARGES: / lerl-7 z <br />BOND DISTRICT <br />$ c (O,C) C) <br />FOOTAGE <br />N, S, E, W <br />SEWER CONNECTION CHARGES: <br />TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGE <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />(5) MONTHLY SEWER CHARGES: <br />SEWER CONSTRUCTION: <br />SEWER SERVICE <br />$ A&4le <br />$ 1116 Nf- <br />TRUNK ' $ IY641 ' <br />LATERAL $ &I01' <br />TOTAL $ <br />LOCATION OF SIDE SEWER OR TEE IN THE MAIN: SF«ic ;/v;v <br />470f/5may SID 7 is-7y <br />INFO COMPILED BY 1 6 '-11 le <br />*This total must be paid before DATE �� - �- <br />building permit is issued <br />