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nvnr��.ss <br />L�L:ILDING PERA4IT IPIFORbIATION <br />t � <br />� <br />�f//� <br />/ �'�� � <br />//�/i�/ <br />T1FH OF BU1LDIi�'G R� � �/I Q�� �- DATE �I ,5' � <br />—: � �- <br />1) BUILL�I�iG P�Rr•iIT FI:F. � ���� <br />(A) FLAN CI-IECl� FEE � <br />y� Wr1TTP, c;ERVJCE T0 BE PAID BEI'ORE BUILDING � <br />/ � PERh4?'i' 1S ISStiED <br />(A) TO P,E DETERMINED RY' PLBG. INSP. INCH <br />(B) EXIST._!_ «'����R SERVICE, APP.L. NO. <br />(C) LOCATION � <br />CIiART <br />3) DRl 'EWr1Y PERMIT TO BE PAID BEI'ORE SUILDING <br />PFRMIT IS ISSuED 23 FT. COAICiZ,D/N' (TYPE) <br />STATUS OF SEN'ER CHP_RGES; <br />eon*n DISTRIGT <br />LAiQDSCAPI�. P.OTFS <br />TOTAL� <br />I� 00'lAGF. <br />N, S, E, �V. <br />SEINER CONNF.CTION CHARGES: <br />TRUNK <br />LATERAL <br />TOTAL CONNLCTION CHARGE <br />SEW�R PERMIT r�E <br />CATCH BASIN PERMIT F�� <br />TOTAL SEWER PER;v1IT F��S <br />AlONiH:..Y SLN'�R CI�ItGES: <br />5��4 �R CONSTRUCTION: <br />// TRUNK <br />5�%�/� �-L% ��i��% �' ��(DC4�I,ATERAL <br />SE\'JER S1?RVICE: <br />LOCATION OF SIDE SEW�R OR TEE IN THE MAIN: CHART <br />INl O COViPILED BY:__� <br />I2�VIE\ti: SFE ��W <br />API'ROVAL: <br />-� <br />`Thi: tot21 tnust br. p�id before building pcnnit is issued. <br />j0 <br />$�— <br />$ <br />$ <br />s <br />s <br />DATE <br />DAT� <br />DA.TE �� G/% <br />