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. _ _ i <br /> , � <br /> . _ ,�UILllING PER\.IIT INFCR\fATION <br /> , ADDRESS� l / 7'�' ��!—�� .S�i�}��'.f�G�{'U r�Cli/�/i I <br /> —•� <br /> - DATE :�- >'1 %.! <br /> TYPE OF BUILDING �� /�i��� �� ;�'��i��l�/�'��,•�'� <br /> i) I3liILDING PERMI'T FEE S-- <br /> (A) PLAN GHECK FEE 5 <br /> Z) 1\'AT::� Sf:RVIGE TO BE PAID BF:FORE BUILDING � Lfc�O . r7 ,� <br /> PER\iIT �S ISSUED <br /> (A) TO EE DETER��INED BY P'.BG. INSP. ��• _ INCH <br /> I (B) F`:fST. WATER S.�tVIGE, APPL. NG. <br /> , ,. � n/I,[: /)/':'�'i�y 5 ' ��;�,,� , <br /> (C) 1�GCATiON C.' S%C'/L 1v1� ' ' <br /> „ � �..; 1 � CHART .! -�1'�i�� <br /> i:� j"�D.,'G, �- <br /> ;� DRI�"�«�AY ER\ILT TO BE PAID LEF�R.E qu._.�ING � , ; <br /> PER\iIT :5 IS.`�i�JED .+ /�J FT. �� �fC%%� T D/\1' (T�'F'�I <br /> I . TCTAL ` 5 <br /> ' 4) STATliS OF SE�1'ER CEiARGES: ' <br /> I �, <br /> IIOND� DISTRICT _> > FOOTAGE ��� �' <br /> (i�I;; 5, E, 1V. <br /> S.T'JI'ER CONNEGTION CHARGES: � <br /> L.�\DSC:aPr. NOTES TRUNK S '. i,'`/, C��' <br /> LATERAL S � 7�' �' G ' <br /> TOTAL C0�1\ECTION CHARGE S 5 �?�' • ���' 1/` <br /> I SE�1'ER PER.biIT FEE � �'��� ' `� n j� � <br /> CATCH SP.SI�: PER�4IT FEE S ��� • ` � �� <br /> TOTAL SE�l'ER PERIvIIT FEES S 7'-i� �� �� <br /> 5; ;�IONTHLY SE\'VER CHARGES: � • <br /> SE�9ER CONSTRUCTION: ,�, y�� <br /> I'�BT�: C'�y.?RGE'�' R�r' 7� B.F C"c�y�i•vf'i� TRUNK $ <br /> J�✓/77f C'r//��°✓�.r Fi7� /7.cS Sf,Gl�r%G' �:t'R�'LATERAL 5 . '. (a �` <br /> SEINER SE;t� 10E: C��� ?��/'� A� c �vJ�s��z`���;7 <br /> LOCATION OI' SIDE SFWER O?. TEi' li�i THE MAIN: CHART_�-% �' ` ��'�� �� � <br /> �,.. , <br /> �� f�/��� /C) �'�Cl�j"�� ���� Ni����.i�'i :C�' %/��li fF �/)./� �/1✓�A'e';� -P 1� /f'i �� ill�/. � <br /> (�. <br /> 7 J � ) <br /> ,�a�O�"�n, � J� i(,��.1 i� ?T 1�,�, r�1. /rf �t`L.c / �/ � /'�� <br /> f' — � � <br /> i I (�L� DATE �'�`��� <br /> INFO CO\iPILED P.ii:: � �' . �� <br /> REVIEIV: .�'!� /N�'0 /Ct?.f�' 17.4'J��j!C.!/t--�c.� 4c �/� � �DA <br /> ;RAFFIG DIV ISION <br /> DATE <br /> APPROVAL: <br /> ENGINEERING DEPARTMENT <br /> This total must be paid before building permit is issued. <br />