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ENGINEERID'G DEPARTMENT <br /> Bi�ILDING PERMIT INFORMATION <br /> ADDRESS _ � '�i�_(,�%' v'�✓.O lJ� J..�.C� TYPE �'� � <br /> 1) BUILDING PERMIT FEE y' .�,��_ OU ` $ j�j'G J <br /> (A) PLAN CNECK FEE S �/. S� <br /> 2) WATER SERVICE TO SE PAID SEFORE BUILDING y�9'� �Zo�. �c� <br /> PF.RMTT IS ISSUED $ <br /> (A) TO BE DETERMINED BY PLBG. ZNSP. INCH ��� �`� �G <br /> .'vIlar� //, UU <br /> (B) EXIST. WATER SERVICE� APPL. N0. <br /> (C) .APPROX. LOCATION TL' 7_�,E, �,r��y, � , �--�i f�" ,CI .G <br /> L c7 U,P,c.��s �,-iaK �:cr«.::, <br /> �'L/L�U/✓l,7�n � � �4�t1�n��r /�� ��CHART GCJ-¢� <br /> 3) DRIVEIti'AY PERMIT TO BE PAID BEFORE BUILOING �' <br /> PER�fIT IS ISSUED �" �j FT. �"� !�l1G- D/W (TYPE) $ ��, 5 C.� <br /> TOTAL* S ¢�7' �� <br /> 4) S^:;TliS OF SEWER CHARGES• <br /> E�::� � DISTRICT� FOOTAGE <br /> N, S, E, W. <br /> NOTES SEWER CONNECTION CHARGES: <br /> YEAR 7� TRUNK �J,C� , D U <br /> 2j � ��' �u 7' �� U � � LATERA��� $ � /�, �U <br /> • TOTI►ir-�ONNL�����-CITARGE y Sb�],SZ� <br /> � - <br /> I SEWER PERMST FEE ,S �� �%G <br /> ICATCH BASIN PERMIT FEE $ <br /> � TOTAL S�yWER PER7P�iIT FEES $ �U• �� <br /> 5) ?:�:;'�iiL�' SEI�ER CHARGES: %� ( �sp`� /��/77 � � <br /> SE�+TER CONSTRUCTION: '� <br /> 4.v <br /> TRUNR $ �/�S <br /> LATERAL $ 2,'j��,j <br /> SEWER SERVZCE: $ i�� ��(j <br /> APPR�X. :,O�;�TION OF SIDE SEWER O�R TcE IN THE MAIN: ��, i)�j;>n <br /> � t= �� /v�CC; �f!'�..' , ' GGY '7 <br /> CHART / �� %���--Q <br /> I\FO CO�:PILED BY: DATE <br /> RCV?r��' — DATE <br /> PROJECTS DIVISSUN -" <br /> APPRO`:AL: _ DATE <br /> ENGINEERING DEPARTMENT <br />