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r <br /> 33UJL.DT.NG P7:RA4IT INi'ORMATION <br /> ADllRESS �• � '. . • ' ; e .. � ,�`, , ,. . , .•.�ir _ ' ', r'-.i:. --_ . <br /> nnTr ,�. . �;-:.l;- <br /> TYPE OI' IILJILDING �_�•� !1�., _ __`.__—. �" <br /> 1) P.liI1.D1NG P1�RMIT FEI: �'�Z,f�k7. �`'' � «� �� <br /> (A) PLAN CII�CK F�� �' ��• �� � _ <br /> 2) 1',-,',1'I:R SL•'R\rlCr 1'O 1�1� ]'/:]') I3T'sI'OIZE IILIILll1NG <br /> . PERh71'!' IS ISSUEll / � �"G• ��} <br /> �::) '!'O ]31s DI:'1'LRntll: �;D ')1' .PLIIG. IN:-?. '/:;s� 1NCH <br /> !! � <br /> ��) I]XIST, \VA:CER SERVICE, APPL. NO. <br /> (C) LOCATION SF�C,t`/��;• _Cr;-.>.� � %. N,•.�+;.<i 7f� ,iZ`' ` <br /> . . , . .. , <br /> _ ... !j,-'(�1t}% -.,�i-.+�ra. �/.c'�� �'".-Y-�l-'. /.'i: CI-U1RT .`-� -- ',''J' -� � <br /> J <br /> 3) DR;VE\VAY I'ER.ti[1T T,O I3E PA1D III:FURE BUII.DIIG � <br /> PER:�IJT IS ISS�J�D i_.�i FT. 'l'u':' D/1V (TYPE) 5 l� • .:�'�' <br /> TOTAL��� $ �JI7• � <br /> 4) S'f:1TU5 OF SE\1'ER Cf-IARCES: <br /> EOND .'� DISTRICT �� FOOTAGE "'- <br /> Iv, S, E, 11'. <br /> LA\DSG:IPE NOT�S SE�C�R CO;INECTIC\� CH.ARGES: ' <br /> �� 2����rR�x � �'7. 5G <br /> 3_ �/_ r� ��_ r.c� i L TERAL 5 •- <br /> TOTAL CON;VEC7'ION CHARGE S �% !• �Q <br /> 5�1:'ER PER\QIT 1'T'E $ .%�. GO _ <br /> CATCFI BASIA' Pr.R\tIT FEE $ <br /> TOTAL SE�VER PERr9IT FEFS $ ,:�'a�'1_`�� <br /> _ � <br /> 5) \fOVTHLY SEN'ER CI-L4RGES: • <br /> SENER CONSTRUCTION: <br /> TRUNli 5 • ���_ <br /> LA'fER."�L 5 —"—" __ <br /> SE\YER SERVICE: � � �" ' ��� <br /> LOC:\TION OF SIDE SEl�'�R OR T�E IN•TIiE MAIN: CF-]ART 4' — '�/l,. "J' ,:"�'�` „_ <br /> ', ,. ..s- ,.„ .e.- .sr <:_. `A, .; _ .:�1. .-T ',...!`� . _ <br /> .i � � � <br /> '�' „+ .�r.aL�... .. . � , � � <br /> IAFC C�J\1PIL�D }3Y: F�r��.cr_ /%v":�: f�.,;%r>"r�; � IS 7E DAT�.'`_�'�:-;•:� <br /> R�YIE`�A�: I�V �l���O�7G �� L'�-c2,. ��� DATE � <br /> TRAI�FIG DIVISIJN <br /> APPROI'AI.y-�� DAT� f / <br /> �, I,NGINLI'sR1P]G llL•'YAR'1'MLN7' <br /> ' Thic total munt hc paid bcfurc building permit is icsucd. <br />