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ADDRESS <br />BUILDING PL•'R�tIT INFOP.\tA'I'ION <br />;, Si� �//�J ,4�� <br />TYPE OF BUILDING S � <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />2) �VATER SF.RVICE TO BE PAID BEFORE BUILDING <br />PER:vIIT IS ISSUED <br />(A) TO BE DETER � IP�TED BY PLBG. INSP. 3�� 1NCH <br />1R1 EXLST. WATER SERVICE, APPL. NO. <br />(C) LOCATION (p �� C.1 . �Ir4l/Y /N s�'e�'� A�C� <br />S �JM P�L CHART G� -��� <br />3) DR:VE�VAY PERMIT TO BE PAID BEFORE BU?LDING <br />PERA4IT IS ISS�JED �b� FT. �P//�GT D/\C (TYPF.) <br />TOTAL� <br />� Z U, C 4 1 .,., , <br />4) STATUS OF SER'ER CI-IARGES: <br />gpNL� � DISTRICT r.ic� _ T'OnTAGE <br />I�T, S, E, W. <br />DATE� ��-'Z.� <br />5 /�• �' <br />3 �' .S� <br />S %/, O 0 �./E' <br />$ ✓��. �'U <br />:.ANDSCAPE \TOTES SEA'ER CONNr.CTION CHARGES: v <br />TRUNK � S I � � Q � <br />LATERAL ���y�fLL� a�S • U U <br />TOTAL CONNECTION CHARGE{ s �/(aS,00 .— <br />, ,�O.U�) <br />SE�1`ER PERMIT FEE � <br />CATCH BASIN PER\4IT FEE S�J <br />TOTAL SE�VF.R PLRMIT FEE� S_ `��"d d <br />5) MONTHLY SE\t'ER CHAR �ES: <br />�j7' <br />SE�'VER CO\`_TRUCTION: �, �S <br />TRUNK � $ <br />' LATERAL � $ a, a .}� <br />SEIVER SEF.VICE: <br />` � a•Sd <br />LOCATION OF SIDE SE\'VER OR TEE IN THE MAIN: CHART �'J -��" � <br />Si d/� r'o .t � A�.�+;+� /�' S0, !IF /Y/,N. !r!/ F,PoivT n n L <br />G/� �hC /0 � .l� �%� �J <br />INFO COMPILED IIY: .�� 'J DATE �S o?�f l <br />REVIE�V: <br />APPROVf <br />Th:s total n�ust bc paid before Uuilding permit is issucd. <br />DATE 3 �0 7 <br />DATF. 3 Z �,�- <br />