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' • . � � I • - ! ' - � � • � � • i <br /> ,. � BUILDING PERMIT INFORMATION <br /> ADDRESS �;�� � � �/LL ',/';;' �` ),'1 ,�- ��; '/-. <br /> , . -� <br /> TYPE OF BUILDING i- � % DATE � ' <br /> 1) BUIi�UING PERMI'T`�'�EE -__ ' $ <br /> ` (A) PLAN CHECK FEE S <br /> 2) WATER SERVICF TO BE PAID BEFORE BUILDING <br /> PERMIT IS ISSUED $ <br /> (A) TO BE DETERMINED BY PLBG. INSP. INCH <br /> // ' <br /> /(l.EXIST, WATER SERVICE, APPL. NO. ' <br /> (C) LOCATION <br /> CHART <br /> 3) DRIVEWAY PERMIT TO BE PAID BEFORE BIIILDING <br /> PERMIT IS ISSUED FT. D/W�('TYPE) $ <br /> � <br /> TOTAL� $ <br /> ' 4) STATUS OF SEWER CHARGES: <br /> BOND �DISTRICT FOOT�IGE <br /> N, S, E, W. <br /> LANDSCAPE NOTES SEWER CONNEC TRUIVK RGES: � � I I �� <br /> � ; l'. <br /> �YI �� �� � ���� LATERAL $ � ` i � � <br /> ' , , <br /> ,t � TOTAL CONNECTION CHARGE $ _ <br /> _- „ ' ' r � - <br /> _" - � �� � -� •;�3 ,_"� _'l <br /> SEWER PERMIT FEE $ - <br /> CATCH BASIN PERMIT FEE $ ' <br /> TOTAL SEWER PERMIT FEES $ . ��1�' - �' <br /> 5) MONTHLY SEWE12 CHARGES: • <br /> SEW.ER CONSTRUCTION: <br /> TRUNK $ ``` " ', <br /> LATERAL $ <br /> SEWER SERVICE: $ � � ,�� � ' <br /> -, <br /> LOCATION OF SIDE SEWER OR TEE IN THE MAIN: CHART �� -/� `,� 1 �` � <br /> � <br /> _ �� , ,,. , _ i � � / ���✓ �y" ��1' `�_ /(.'/ S�; . � /y.;,,✓. �l 'r- ��,/ii <br /> i l � .o .i . . . . . <br /> �Jl; ) d_f„Ld� i� :. _ � . . . . <br /> INFO COMPILED BY: � ,: ��i'.� '-�� DATE ' � - ' I_ <br /> REVIEW: DATE <br /> TRAFFIG DIVISION <br /> APPROVAL: DATE <br /> ENGINEERING DEPARTMENT <br /> �This total must be paid Uefore building permit ie iasucd. <br />