Laserfiche WebLink
6 <br />IiUILDING ?ER\SI'1' I\r OR\fATION <br />ADDRESS G�`���� �%�-��L S'' <br />TIPE OF BUILDING � r �L <br />1) BUILDIr'� PER\IIT FEE <br />(A) PLAN CHECI{ FEE <br />2) �YAT :R SER\'IGE TO BE PAID BEFORE BUILDING <br />PER\iIT IS ISSUED <br />(A) TO BE DETER\IL\TED IIY PLBG. INSP, INCH <br />�� u ,;� <br />(B) EYIST. �� ��r^ \VATEB SERVICE, APPL. NO. 7��` � <br />(C) LOCATION ca�itc� t�"r �— � �Y "i �'"�� <br />• CH.�RT � T N <br />3) DFIl'E�1"AI PER\SIT TO BE P.3iD BEFORE BliILDI\G <br />PER\;IT IS ISS�JED i-� FT. � D;'\1' (T'iPE) <br />TOTAL <br />4) ST?Tti�S 'OrF SER'ER CF-iARGES: <br />BO\D ryo(}% DIS7'RICT FOGTAGE <br />���� N, S, E, R'. <br />i.�_:`�- •rs.�'ES <br />.S /G�,v ja iC �v RN - a.ti v- <br />fy,{�� C:� �= �ti•i sr i? i� <br />i <br />/S Sd �c> <br />DATE ,S'-> -�' <br />$ `ils,C7 �'' <br />S _1�/', , i , _ <br />3 <br />y_ Ct';= J <br />s /���'��, <br />SE\1'ER CON\r CTiO\ CI-L�RGES: � <br />TRU`K S <br />LATERAL S <br />TOTAL GONNECTION CI-iARGE S � <br />SE�YER PERh1IT FEE S � D..� � <br />CATCH BASL\ PERJIIT r EE S <br />TOTAL SE��'ER PERMIT FEES S ' <br />5) MONTHLY SE�VER CHARGFS: + • <br />SE«'ER CONSTRUGTION: <br />TRUNK $ -� <br />' LATERAL S -� <br />SE�VER SERVIGE: $ Z•�vU <br />LOCATION OF SIDE SE�VER OR TEE IN THE MAIN: CHART �_Zd-2n_� <br />� ili„ci, �1`k, .�-r. v L�T 2�De�-P <br />il/p . n j- i _ -� �. .: �� c, % <br />... � ' 1 : <br />IVFO CO�fPILED BY: <br />REVIEII': <br />APPROVAL: <br />.. .!/. _ <br />This total must be paid Ucfore building permit is issurd. <br />DATE d��� �� <br />DA T E_ i r�l� <br />DATE ��! � 7� <br />