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� � • 1 • _ • <br />. � . <br />' � • ' <br />. BUILDING PERMIT INFORMATION <br />ADDRESS GTL� � J ;;� /�I� `( % /',/'�.� <br />, i <br />� ., � , �,,�_,' ' � %I'�,i-/,'%:'''i:� DATE `.-.�_�;— <br />TYPE OF BUILDING C�� �%-/'.= �=i r:.� < <br />1) BUILDII3G PERMIT FEE ' � <br />(.4) PLAN CHECK FEE � <br />2) WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED � <br />(A) TO BE DETERMINED BY PLBG. NSP. INCH <br />(B) EXIST. WATER SERVICE, APPL. NO. <br />(C) LOCATION � <br />CHART <br />3) DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSLTED FT. D/W (TYPE) <br />' 4) STATUS OF SEWER CHARGES <br />BOND DISTRICT <br />LANDSCAPE NOTES <br />TOTAL; <br />�� ' 'l' <br />U � '�. (�( (C , � <br />FOOTAGE <br />N, S, E, W. <br />SE�VER CONNECTICIN CHARGES: <br />TRANK <br />LATERAL <br />TOTAL CONNECTION CHARGE <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEF <br />TOTAL SE�YER PERMIT FEES <br />5) MONTHLY SEWER CHARGES: <br />SEWER CONSTRUCTION: <br />SEW�R SERVICE: <br />$ <br />$ <br />S �':, ' <br />TRUNK $ - -" <br />LATERAL $ <br />LOCATION OF SIDE SEWER OR TE� IN THE MAIN: CHART <br />,�, � _ � ti <br />�I,. '"� � �: ��i '__/ I A�' �.1 <br />` , <br />\ �. <br />�A��li. r�:��� % �t�; r.1 '�./, L:� ��;71�' ,C(. �; %% % �. <br />INFO COMPILED BY: s��'r .`' '�,'.,l'C: � <br />REVIEW: <br />TRAFFIC DIVISION <br />APPROVAL: <br />ENGINEERING DEPARTMENT <br />'�This total must be paid Uefore building permit is issued. <br />i -,. . � . <br />r �. .� <br />$ � �l �'i�- •.. r, <br />_yL' ��! � <br />� �� <br />� �,^ i <br />� �' / %' Y ' <br />i�n`+'.% , .i,r, � . . <br />DATE ` ,� : � i_i <br />DATE <br />DATE <br />