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. i3UILllI�iG i�.R?.fIT IICFCi::'�=ATICid <br /> ADDRESS' �.� �C� � �/'�" � -S � � -- �}, <br /> DATE �� /����'i i� <br /> TYPE OF BUILDING ✓`:����!�%%���i���%�✓/ <br /> �o,000 � Zo1, °c'_ <br /> 1) BUILDLti'C'i PE RMIT FEE � 1 .� '` , S S <br /> (A) PLAN CHECK FEE �t <br /> Z) ��ATER SERVICE TO BE PAID BEFORE BUILDING � 1-7cj �J <br /> PER\IIT IS ISSUED ,� <br /> (A) TO BE DETER\4INED BY PL73G. INSP. � INCH <br /> �iJ;.' <br /> (B� g1{�, .'�-'1 Ir �VATER SERVIGE, AP?L. NO. /�%i ' <br />, � ,.� , � ,, <br /> (C) LOCATION S /�! o , � ^;� -'. .' ' - ' �' <br /> 8 � —, C K�RT S �'�-> <br />� � ' - � <br /> S v . �d. ,` � � c, '% <br />� 31 DRIVEIVAY PER\IIT TO BE PAID BEFGRE BUILDING � �� � ( i <br /> PER�.IT IS ISS�JED _T F'7 • C'� �'��' ' D/�4 (TYPE) $ - <br /> „ � ... : t� ' TOT9L �; $ �7 �Z. �� <br /> . ;; <br /> 4) STP.TtiS OF SE\ti'ER CH.ARGES: <br /> BOI�D /"� L ,- ' DISTRICT FUvTAGE <br /> iv, 5, E, �Y. <br /> �'i\TOTES SE�1'i�R GONXECTION CHARGES: � <br /> �— TRUNK �r <br /> �(`/��N �� StoE Se�'�'`iS�At�ra��� , _ <br /> LATERAL � <br /> ��rt'�[Z�� TOTAL CONNECTION CHARGE S ` � <br /> y' _ <br /> SE�'V�R PERbiIT FEE $ �`� '`' `' <br /> GATCH BASL\ PER;�tIT FEE , , � `� S `' '' <br /> L � Y , <br /> TOTAL SE�S'ER PEkMIT � EES S ' <br /> 5) r-f0A`TI'_LY SE�VER CHARGES: � ' <br /> S��«"ER CONSTRUCTION: TRUNK � <br /> LATERAL � <br /> SE�VER SERVICE: ' � ' `����`�� <br /> , . i " � , <br /> S i= < <br /> � LOCATICN OF SIDE SEWER OR TEE IN THE MAIN: CHART f} - .% <br /> � � > <br /> , ,: �-. ; <br /> , , i, //.` <br /> , . , ��, - DATE�'� I <br /> INFO �CO\4PILED BY: ; �i�'�-� � <br /> DATE P� ' ! !'�� ' <br /> REVIENr. �- , ';�.• �� ,- 1:1J i.. �:'.. i <br /> TRA IG DIVISION! � 8� . SYff�r�� <br /> �'. U O F�!/ S� `kfI' n✓e,�Qi}s'� ��7�� DATE �2 h <br /> APPROVAL: <br /> EN NE�RING DEPARTMENT <br />� <br /> This total must be paid before building permit is issued. <br /> ! <br />