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� <br />ENGINEERING DEPARTMENT <br />BUILDING PERMIT INFORMATION <br />ADDRES^ (?'2_ ; �rV "I' f/4 =� <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />2) Wr1TRR :�RVICE TO IIE PAIG BEFORE SUILDING <br />PERMZT iS ZSSUED <br />(A) TO BE DETERMINED BY PLBG. INSP. INCH <br />(B) EXIST. WATER SERVICE, APPL. N0. <br />�YPE S � �� <br />S <br />$ <br />S <br />/ <br />(C) APPROX. LOCATION [, a-%" / 7_ f�/o ak � [3E✓erl�, ViP:.�/�Cel c�y ��} <br />. i <br />CHART S - 23$ , <br />3) Di:i':iltiAY PERMIT TO BE PAID 9EFORE BUILDING <br />PEti1I; IS ISSUED � FT. � D/W (TYPE) 5 /2 , SO <br />TOTA:.• $ / 2 , SO <br />4) 5::,:i:S OF SEWER CHARGES: <br />5:�:;7 DISTRICT FOOTAGE <br />N, S, E, W. <br />SEWER CONSTRUC7'IOt7: <br />SEWER C0:7NECTION CHARGES: <br />YEAR TRUNK 5 <br />T.ATERAL S <br />TOTAL CO:�'tiECTION CFinRGE S <br />SEWER PER'dIT FEE <br />CATCH BASIN PERMiT FEE <br />TOTAL SEWER PERP:IT FEES <br />TRUNK <br />LATERAL <br />SEWER SERVICE: <br />A°2��};. "_,�;+'PIO:� OF SIDE SEWER OR TEE IN THE MAIN: <br />I":�J ��i:�:�ED BY: �.i`%i ����i£P <br />REV:"..,. <br />PROJECTS DIVISION <br />APP?i i.... , �1� <br />ENGIt7EEP.ING DEPARTMENT <br />S <br />$ <br />S <br />-s <br />DATE `�.Z/7G <br />DATE <br />DATE �,�j�b <br />