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� <br />L� ' <br />BUILDING PERMIT INFORMATION <br />ADDRESS ��Z�T Y�c.I �'JT, TYPE � <br />(1) BUILDINC PERMIT FEE �gS�C�pp�� <br />(A) PLAN CHECK FEE <br />(2) PLUMBINC <br />(3) MECHANICAL <br />(4) WATER SERV�CE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br />(A) TO BE DETERMINED BY BLDC INSPECTOR INCH <br />(B) EXIST. WATER SERVICE, APPLICATION NO. <br />(C) /1PPROX. LOCATION <br />s Co I�j. O a <br />Pp .*` Cp(v3� <br />�O. Oa <br />33. Fsv <br />!o0•6d <br />CHART <br />(5j DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- , <br />SUANCE FEET DRIVEWAY(TYPE) S G�' B� <br />S <br />(7) STATUS OF SEWER CHARCES: <br />BOND � DISTRICT <br />NOTES <br />Sfi3�►Y.. UTTc���Y � <br />b,Q,O l/7/ S� <br />/aJ.l a � 2/j�.C�U <br />5r�v¢. 58q.e� <br />� g i .3.0� <br />FOOTACE <br />N, S, E, W <br />SFWER CONNECTION CHARGES <br />YEAR �7 TRUNK S Z��' n� <br />LATERAL "-� <br />TOTAL CONNECTION CHARGES i_ Z��• � <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />(7) MONTHLY SEWER CHARGES: <br />SEWER CON51'RUCTION <br />b �JD•Do. <br />TF',UCK b <br />LATERAL <br />SEWER SERVICE <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />INFO COMPILED BY: <br />APPROVAL: <br />s•ea <br />CHART <br />DATE <br />DATE <br />