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StJQ � 9�BUILDI�G JER\,IT INFCRl.'.ATION <br /> __�� CU,�S i �7./.�i U�s — ' <br /> ADDRESS ----' DAT ' 'a�'Z� <br /> y� vG'G�x � <br /> TYPE OF BUILDING � I,� � p� <br /> 1) BUILDIN�G PERMIT FEE � (.,� �� • <br /> (A) PLAN CHECK FEE � <br /> 2) ti4ATER SERVICE TO BE PAID BEFORE BUILDING � �'L�j . � <br /> PERMIT IS ISSUED y, <br /> (A) TO BE DETER�ItdED BY PLBG. INSP. <br /> `� INCH <br /> (B) EXIST., \tiATER SERVIGE, APPL. NO. — <br /> (C) LOCAT.[ON `a2� C?��_ ���N A`��� 5 �T <br /> � � _C� `' CF��RTS I_�7 <br /> 3j DRIVE�S'AY .PERMIT TO BE PAID BE� BD�LDITYPE) � / 7_ SG 1�UE <br /> PERr1IT IS ]SS�JED �_. FT. f)IC�A�i <br /> TOTALT � ���•� <br /> 4) STATUS OF SE�PER C�LARGES: ,T,nr.r �'iG <br /> T°QO_.....1 <br /> BOND S _ T.�?�TP.1CT N, S, E,� . <br /> LAND�E NUTES SE��'ER CON�ECTION CHARGES: � ^s � � <br /> L�' <br /> TRUNK <br /> s 3�o,�a <br /> LATERAL � <br /> 'r n0�4': <br /> TOTAL COti1ECTION CHARCCE � "�3 �� � <br /> � �c�, O G <br /> SE�1'ER PEFA4IT FEE <br /> c <br /> CATCI; BASII� PERMIT FEE • � <br /> TOTAL SE\9ER PERMIT FEES �_ �O 'v O <br /> 5) MONTHLI �E SEN'ER CONSTRUCTION: • Q, oZ Q <br /> TRUNK � <br /> ' LATER.AL � � � � <br /> $ /►'`1�T��/rD <br /> SEWER SERVIGE: <br /> LOnGAT��J���I]]]OIr` OF SIIiE SEWER OR TEE IN THE MAIK: CI�A ��l�' ��� <br /> �N i,�v �� ��F �,—�'e�'> r � <br /> // ' D�� �ar � — <br /> ,�0'�0 • L�f- y' � ' nnTL:s', a y-7.j- <br /> INFO COMPILED BY: � � DATE � •?! ��� <br /> REVIER': ���� ,r}�A FIC DI�'ISION <br /> APPROVP.L:r/��'��_ <br /> C7��< DA T E��7�_ <br /> r; II�EERli::� D�PARTMENT —� <br /> -`This total must i�e paid beforc building p�%mit i: i=sued. <br />