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�•�1 <br />� [� �.� <br />DE�ARTMENT OF COMMUNITY DEVElO►MENT SERVICES <br />BUILDING PERMIT INFORMATION <br />�DDRESS �"� '/� LL'�TMc>-�r= �r� TYPE_�-G�.�jy� <br />(1) BUILDING PERMIT FEE �'"-�l��•�O b��,5� C�U <br />(A) PLAN CHECK FEE j-'p./fi �,����p, <br />(2) PLUMBING ��j',E��j <br />(3) MECHANICAL ��j �r�l <br />(4) WATER SERVICE TO BE PAID PRIOR 70 BUILDING PERM T ISSUANCE ��3�'��� <br />(A) TO BE DETERMINED BY BLDG INSPECTOR __� INCH ��./(a, <br />(B) EXIST. WATER SERVICE, APPLICATION O. (� <br />(C) APPROX. LOCATION A�� �t��rJ <br />CHART N- 3U Z9-� <br />(5) DRIVEWAY P[RMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- <br />SUANCE <br />FEET <br />p) STATUS OF SEWER CHARGES: <br />:� � <br />NOTES <br />DISTRICT <br />� Z�i`�G�Y'N'�% %-'� <br />�rr� 7i5 gL� <br />AC�� �L , <br />�9`l2 `�x . . I (� Z % � G��f l�: 7L' <br />DRIVEWAY(TYPE) 5 ��'��• �� <br />S <br />FOOTAGE 1�-f�Y'�1�,ZJ� <br />N, S, E, W <br />SEWER CONNECTION CHARGES <br />YEAR TRUNK <br />LRTERAL <br />TOTAL CONNECTIQN CHARGES <br />� <br />i <br />SEWER PERMIT FEE i ����U <br />CATCH BASIN PERMIT FEE — �� <br />TOTAL SEWER PERMIT FEES /� O'b ����F�C� <br />(7) MONTHLY SEWER CHARGES: /�z ��� <br />SEWER CONSTRUCTION 7RUCK l 3 <br />L�TERAL <br />SEWER SERVICE <br />APPROX. LOCATION OF SIDE SEWFR OR TEE IN THE MAIN: ���+7�� �; F;� GC/E7"��'i2C1 <br />L��i.�)� �7/G-'----[,�/ N�,.trt.' 11P.'C!.'c 7�� r— �i �� r �+f cl. .� <br />l�� �-� �j c�i: G�NS//N4 ' MN �</ 7�> f'�C L'.C7eG- <br />,� '� 7J P�G 4 Nli�✓ �f L�• <br />INFO COMPILE� B{� _ <br />APPROVAL: <br />�-{ S� <br />�'�= - <br />� � <br />4179 <br />CHART f�"��O'ZS'-S� <br />DATE <br />DATE <br />