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__ . �--l- <br /> BUILllING PERn-fIT INFOR�IATION <br /> ADDRESS ��_.-� �C� - ��''� ��� � � <br /> TYPE OF BUILDING ���/%/�/���� DATE �-�.� �/j� <br /> 1) BUILDIN'G PERMIT FEE . $ � .3Z. � O <br /> (A) PLAN CHECK FEE � %L��• �� <br /> 21 \VATER SERVICE TO BIs' PAID BEFORE BUILDING �� S � �� <br /> PERMIT IS ISSUED p,�� � "'���r�'�'� <br /> p„�����/ INCH <br /> (A) TO BE DETER�INED BY PLIIG. INSP. � <br /> (B) EXIST. WATER SERVICE, APPL. NO. � ' - <br /> (C) LOCATION �-� � ,; �;� I -,' %;;� ,�, � <br /> � <br /> � CHART .�- � �� �:' <br /> 3) DRIVER'AY PERMIT TO BE PAID B�I'ORE BIIILDING <br /> PERMIT IS ISS�JED:' ' � ; ' FT. , r; ." D/ZI' (T�'PE) $_ <br /> 7•fl�. f'C' <br /> • TOTAL';° S �'C[k''s-�r�'Zf <br /> r�` <br /> 4) STATUS OF SEWER CHARGES: <br /> BOND DISTRIC'T FdOTAGE � <br /> N, S, E, W. <br /> LANDSCAPE NOTES SEti'JER CONPdECTION CHARGES: t� <br /> TRUNK $ _ <br /> LATERAL �a <br /> TOTAL COIQNECTION CHARGE � <br /> SEWER PERMIT FEE $ ' ' � ` <br /> CATCH BASIN PERMIT FEE $ <br /> � <br /> TOTAL SE14*ER PERMIT FEES $ . ' <br /> 1`� �' <� v <br /> 5) MOPITI;LY SEWER CHARGES: �4��(_ J � <br /> SEWER CONSTRUCTION: �_�f_�_J� y�n • " <br /> TRUNKu(c,¢ Z3�¢ $ - _ _ <br /> ' LATERAL $ _ <br /> SEWER SERVIGE: � �' � <br /> L�OCATION OF SIDE SEWER OR TEE IN THE MAIN: CHART �� : �'� - - <br /> ,� ' , ���- . <br /> ; , � � �, i; . �r � ,� �. , `�� i � - <br /> ;pi� ; ].5'j ��'ll ,� � , ,_. 1;�.. � . , ,- � <br /> ?NFO COMPILED BT : �� i ": r � i DATE - • . <br /> i7 � , , <br /> REVIE\M1': � I ��yr t DATE/' /3- 7 5_ <br /> TRAFFIG jIVISION <br /> <.� ��� �" <br /> APP ROVAL:� ��� a� DATE_L/�/' � <br /> 7'- — �RING DEPARTMENT <br /> °�°This total must be paid before building permit is issued. <br /> ,.,_- .--- ..-- -- - <br />