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ADDRESS J � �_, <br />1) IIUILDIP]G PERMIT FF,� <br />(A) PLl�N CH�Cfi PEE <br />ENGINEERII7G DEPnRTt�:ENT <br />IIUILDIAG P�FtidlT INP'OlU4ATI0N <br />�T-N <br />2S, Z�Z• ec� <br />2) 47ATF.R SF.RVZCE TO �JE PAID IIEI'OI2� IIUILDING <br />PEFtMIT IS ISSUED <br />�7�) TO IIE DETERt•SIi1ED iil PLDG. INSP. _� INCIi <br />(B) EXIST. Y7T�TER S�RVICE� APPL. N0. <br />TYP� �r7' (-�__ <br />S_ I c�f - c�o <br />$__� Z_ p <br />(C) APPROX. iOCi�TION Lp�� J� � <br />4>' w o� U ) <br />" CHART S—�? ;Z <br />3) DR7VEICAY PEi2l�1IT 'I'0 DE PAIU BEFORE BUILDING <br />PE�fZSiIT IS ISSUEP /� FT. �{ n�p+ (TYPE) �/549U <br />. �9,i ��Z� <br />TOTAI, * <br />4) Si::TUS OT�SEY'ER CliARGES: <br />�%����_�,,� DISTRICT_�� FOOTAGE <br />N, S, E, W. <br />SS«R CQNSTS2UCTION: <br />SEWER CONNECTION CHARGES: <br />YEAR � TRUNK <br />TOTA�n /I,n/T7E�RAL <br />xCONh�EC�'TO:� CIihRGE <br />SE{�R PERh1IT FEE <br />CATCII IIASI9 P�RI•;IT FEE <br />TOTAL SEIti'ER P�RDtIT FEES <br />� c'� t7 <br />$�-- <br />S '�103, SO <br />S � 9Z• Sv <br />s �lc�s' • a-o <br />s� l� 2, sz� <br />S .�-'>� G� <br />E <br />$ = ��^� Od <br />TRUNK $_��Z��! <br />LATERAL $_/� �1D _ <br />SEWf:R SERVICE: $�/G � U <br />�nP�T�',:,2��\�. LO,:esTION OF SIDE Sl:tq�R OF. T�E IN T1IE 6fAIN: �j ��C.. �� <br />:.t.t..�L-_ � K'�' P i.�r .l� I I�-I��r--�-.,, i-. __ �1, ' - <br />INFO CJ>:PILlD IIY: <br />RliVI riC: <br />PItUJL�CP: ll1VISI0N " <br />DATE <br />APPP.OI':11,: <br />-- DATJ> <br />]:I1GI1dlii:RI1�G !1L':'i�.12TF1LN'i' <br />