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_ BJILDLNG PERMiT INFORMATION <br />ADDRESS � ��� � �� ��� ��/� <br />llATE��zi %- � <br />TYPE UF BUILDINcG �) l�F'�.����1 Y <br />� 7% � <br />1) 13UILDING PERMIT I�EE I��' \ �,��-� o� <br />(A) PLAN CHECI{ FEE r' � <br />2) <br />3) <br />WATER SERVICE TO AE PAID BEFORE BUILDING <br />PERMIT IS ISSUED %`� <br />!A) TO II� DGTERr4INED BY PLIIG. TNSP. 3/ T INCH <br />/! <br />(B) EXIST.� F�ATER SERVICE, APPL. NO. <br />(C)LOCATION_��"�T/N�l (n�1 C•T �-�n�^� , Z�l� <br />!-)b2jl� O� �-IL 0� �OU�Jn CI-1ART �l� 7�-i, <br />DRIVE�'1'AY PERMIT TO BE PAID I3EFORE B�� �D1TY E) <br />P�RMIT IS ISSUED 'L� FT. �1)NC— <br />TOTAL,° <br />�/2 � ,,v <br /><� <br />$ <br />4) STATUS OF ER'ER CHARG-�_ 1 OOTAGE c <br />�j !�` N, S, E, W. n <br />BOND DISTRICT <br />f"JI_ Z���L� �/;�_ �� I� I.�. ��U�J IL C�NL.W ,=,pNn � <br />LAPJDSCAPi: NOTLS SrWE CONNECTION GHARG�S: , <br />--- TRUNIt C'j�'c'c`$ ! n���� <br />LATERAL ���`� c�� � � _�_ <br />TOTAL CONNECTION CHARGE $�-�S `�' �� _ <br />SFW�R PERMIT I'EE � ��' �� <br />CATCH ]3ASIN PERMIT F�E <br />TOTAL S�WER PERMIT F�ES <br />5) MONTHL,Y SE\VEIt CHARGE:S: <br />SE�VI:R CONSTRUCTION: <br />SFlVER SEl:\'ICE: <br />TRUNK <br />L�TERAL <br />LOCATlON OF SIDE SEW�R OR TEr IN 'iHE MAIN: CHART �' <br />� L=.��r; O F �-1 /��v N�� _�� ntii � r� t� �. <br />.-�-�- - - <br />_^,�DI1nX (�' �11L�� �T PKc�� (_,ti� <br />INFO COMPIL�ll DY:_�Lu„� <br />RLVIL\C: <br />APP�O� <br />`Ti:is i.otal m�ist bc paid before huilding permit is issued. <br />$ <br />� <br />g� ` ,D-O <br />2 � S.0 n <br />��---`'`—"—.— <br />$ <br />�__Z_e ^�_ <br />• � <br />� <br />DAT��—Z �r- 74- <br />DATE �. <br />DATE ��� � <br />