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ADDRESS <br />TYP� OI' BU7LDING �_% /� _ _ DATE�� -�-%� <br />1) BUILDII�"G PERMIT FEE � �DS � - <br />(A) PLAN CHECK FEE $ �5� � <br />2) �VATER SERVICE TO BE PAID BEFOR� ISUILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETER �INED B1 PLBG. INSP. INCH <br />(B) EXIST,� �ti'ATER SER\'ICE, APPL. TdO. �3�r�-S <br />(C) LOCATION <br />C HA R T -S'�3 � <br />3) DRIVE�VAY PL•'Rh1IT TO Bi: PAID BEr'ORE BUILDI\'G <br />PERMIT IS ISS�JED FT. D/�Y (TYPE) <br />•'''i: i'/-'r �:/ , . TOTAL` <br />.;) S.ATUS OF SEIYER CHARGES: <br />BOND •r DISTRICT /J <br />LANDSCAPF. NOTES <br />P'OOTAGE <br />N, S, E, �V. <br />SF_\VER CONNECTION CHARGES <br />TRUNK <br />LATERAL <br />TOTAL GONNECTION CIiARGE <br />SE\VER PERMIT FEE <br />$ — <br />5 �6 Z � <br />S ' �y��'� �' — <br />n <br />� ✓;�Yi�vC� <br />� ,_ --- <br />$ _�0.40 <br />CATCH I3ASIN YERMIT FEE $ � —' <br />TOTAL SE\VER YERMIT FEES $_ �C�. O O <br />5) MONTHLY S�\YER GHARGES: • <br />SE\YER GONSTRUCTION: <br />TRUNK $ C• aO <br />' LATERAi. $ ���0 <br />LOCA <br />SLWER SERVIGE: <br />Ol' SIDE SEJN'ER OR TE� IN THE hiAIN: <br />� <br />.a r ./�-.r!%� /'> v /.�G 1 _ !'� <br />INFO COMPILED SY <br />g �,� D <br />CHART �� ,l' ' S-�O �S <br />REVIEW: �/�l-•/l��:'s�- - <br />TRAFFIC DIVISION <br />APPROV <br />Thie total must bc paid bciorc building pr_rmit is issucd. <br />DATE i� <br />DATE i.? � 9�- <br />DATE �� � /7 <br />