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� ENGZNEERING DEF.�ARTMENT <br />y BUILDING PERMIT INFORMATIJN <br />ADURESS_ i 5�/ _;{� P,y �� �, r Q TYPE S/' �Q <br />1) BUIL�ING PERMIT FEE L c L�Z $ /O �, fJ U <br />(A) PLAI� CHECK FEE S SL� D U <br />2) WATER SER.VICE TO BE PA7D 13EFOR1: BUILDZNG <br />P�Rh1IT IS ISSUED $ 200y� V <br />(R) TO D:: DETERMINED BY PLBG. INSP. '��_ INCH �'�-?-�� »' �� <br />(II) SXIST. '"""'–' WATER SERVICI:, APPL. N0. ---- <br />(C) APPROX. LOCATION � <br />na; �- ir� w. „�' � e av�fi•.,��o <br />CHART S'� 3 � <br />3) DRIV�WAY PERMIT TO BE PAID BEFOI2E BUILDING <br />PERMIT IS ISSUED /y FT. /�g e% D/W (TYPE) <br />—T– <br />TOTAL* <br />9) STATUS OF SEWER CHARGES: <br />BOND_� DISTRICT /� FOOTAGE --"" <br />N, S, L•', l9. <br />5) MONTHLY SEWER CHARGES: <br />SEW�R CONSTRUCTION: <br />SENER SERVICE: <br />SEWER CONNECTiON CK�+RGES: <br />YEAR �JG TRUNK <br />LATERAL <br />TOTAL CONNrCTION CHARGE <br />SEWER P�,R�1IT FEE <br />CATCH 13ASIN PERMIT FEE <br />TGTAL SEWER PERMIT FEES <br />TRUNK <br />LATERAL <br />s_ � . ro <br />s 3�D .sz� <br />$ `/ %. 5'1� <br />S 3 GS. 00 <br />S 962..5� <br />$ 30.Q0 <br />$ -�_ <br />S 30 , e� <br />, 20 <br />+S '�$ <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN TfiE MAIN: ��� �-y�Q;.� - 213 �/V oi� <br />"T M i`/ S o� .f�S'—'''` nn IN���.,erc //� L> <br />CIiART f] s-zB-S <br />INPO CO1dPILED BY: 1sS'� _- F!_E�__ DATE i�Z4 �7G <br />RG��I E{�i: <br />PROJECTS DIVISION <br />APPROVAL: <br />PNCINLLRING I��PARTMHNT <br />DA'PE <br />DATE <br />* This total. nust Ue paid Ueforr_ buildiny permit is issu��d. <br />