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.. � BUILDI�G PERMIT INPORMATION <br />ADDRI:SS '7� � W� �, � ����� <br />TYPE OF BUILDING �,, � /� DATE�-a5� >s�_ <br />1) BUILDIN� PERMIT FEE � ��4' `U <br />(A) PLAN CHECK FEE $ CaZ,C70 _ <br />2) <br />3) <br />WATER SERVICE TO BE PAID BEFORE 33UILDING <br />PERMIT IS ISSUED << <br />(A) TO BE DETER �IIPdEP. BY F'LBG. INSP.� L`1CH <br />(B) EXIST. �VATER S'��RVICE, APPL. P70. <br />(C) LOCATION l0 � ��I. �1�f���u ;�u' (V oFiV .�/G• <br />CHART Lil -JoC <br />DRIVE�VAY PERh4IT TO BE PAID B'FOR� BUILDING <br />PERMIT IS ISS�JED /S F"r• 1'�,�D/�C (TYPE) <br />TOTAL� <br />4) STATUS OF SE\VER GY_ARGES: �0/�%K��D <br />BOND l— DI5IRICT -- FOOTAGE <br />- -N, S, E, N, <br />LANDSCAPE NOTES <br />SE\VER CONNECTION CHARGES: <br />TRUNK <br />LATERAL <br />$ /ZS.�SU <br />� 7, .5 c� <br />-o <br />S 3%�-• �– <br />S <br />$ <br />TOTAL CONNECTION CHARGE 5 �— __ <br />SE�YER PERMIT FEE P� �S �Q� U�— <br />GATCH IIASIIQ F'FRb4IT FEE S _ <br />TOTAL SEti�"ER PERMIT FEES $ 3��r v�% <br />5) MON'1'IILY SE�VER CHARCES: • <br />SE�VER GONSTfiUCTION: <br />TRUNK $ _ <br />LATERAL $ �__ <br />SE1'1ER SERVIGE: � a�'Sv — <br />LOCATION OF SIDE SEWER GR 'I EE L'�.T TH� IvIAII�: CHART_� ��Lo ' o� 7-� �__ <br />.S� u ,�/�0,�� ra �' r,�� oF M%a ;��'�.e� 7' c�ffP �r <br />/� lMn �.v <br />a, a�' <br />L <br />INFO COMPILED BY: i2Y /!'! •��7 .— <br />RE\'IEW• I�/��i��"�`� <br />TRAFFIC 1]7VISION <br />APPROV <br />This tot:�l •�st be paid Ucfore UuildinF permii is is -.ied. <br />DATE ,J � �J - <br />DATE � Z. �% �__ <br />DATE__ �� <br />