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�DnREss <br />BUILDING PERMIT INFORMATION <br />02 �( — `T �/ �` .J ('. <br />S. �U, <br />TYPE OF BUILDING J� �� <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHECI{ FEE <br />2) WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(ta) TO BE DETERMINED BY PLBG. INSP. ��� INCH <br />(B) EXIST. WATER SERVICE, APPL. NO. <br />(C) LOCATION �� � `. 1, lC'('F,�T[�.__> //V � i }t� <br />� i"/ <br />CHART �Ct - s� <br />3) DRIVEtiVAY PERMIT 10 BE PAID BEFORE BUILDING <br />PERMIT IS ISSJED /S� FT./Jir'�/�Qli D/W (TYPE) <br />TOTAL>" <br />4) STATUS OF SEWER CI-iP,RGES; <br />� EOND DISTRICT <br />LAI�TDSCAPE NOTES <br />FOOTAGE <br />N, S, E, 1V, <br />SEWER CONNECTION CHARGES: <br />TRUNK <br />LATERAL <br />TUTAL CONNECTION CHARGE <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />5) MONTHLY SEWER CHARGES: <br />SEWER CONSTRUCTION: <br />SEWER SERVICE: <br />DAT� I--S/- 7,.5� <br />$ �4 `i`. .G' d <br />$ c'.d�.SD <br />� f �t S . c.� �; <br />$ � S C� <br />� ��r_j.OU <br />'i'RUNK $ <br />LATERAL $ <br />$ <br />LOCATION OF SIDE SEWER OR TEE IN THE MAIN: CHART <br />._J,/��L�Jt'ic" �/c� T .9C�i?i�A,rs�CP � •—. ���/� /-F� <br />INF'O COMPILED BY <br />R.EVIEW: <br />APPROVA <br />a <br />'`This total must br: paid before building permit is issued. <br />e <br />DATE ;;)-(�-75 <br />DATE 2 �� ; <br />DATE�— �%''�J' � <br />