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BUILDING PERMIT INFORMATION <br />ADDRE>S ,�� J T� �� ,� /, S C(% <br />TYPE OF BU <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHEGK FEE <br />2) V,TATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETER � INED BY PLBG, INSP, J� INCH <br />(B) EXIST. P7ATER SERVICE, APPL. NO. <br />(C) LOCATION �;' � �'.1 , �c^(ATi � //V <f ;��K .'�T, <br />CHART L(,� - Sc� <br />3) DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING <br />PERMIT IS ISS�JED /J FT. /�Ji',�/ry�i D/�v (TYPE) <br />� TOTAL-" <br />4) STATUS OF SEtiVER CHARGES: <br />BO?VD DISTRICT <br />NDSCAPE NOTES <br />FOOTAGE <br />N, S, E, W. <br />SEWER CONNECTION CHARGES: <br />TRUNK <br />DATE �-��- �s <br />$__��, i; G' <br />$ c� � .. S"CJ <br />� <br />$ <br />c�l.d <br />. '� (I <br />$ a!z�,cJr') <br />LATERAL $ <br />TOTAL CONNECTION CHARGE $ <br />SEWER PERMIT FEE $ <br />CATCH BASIN PER1vIIT FEE $ <br />TOTAL SEWER PERMIT FEES $ . <br />5) MONTHLY SEWER CHARGES: <br />SEWER CONSTRUCTIOIV: <br />TRUNK $ <br />LATERAL $ <br />SEWER SERVICE: <br />LOGATIOPd OF SIDE SEWER OR TEE IN THE MAIN: CHART <br />.5�� u�.� �!� T �7(i.l'/li�,GlF= "_ ,�:�-�r lGjr'E:f' �'7;F_=c'� �;.7- � -7� <br />INFO COMPILEA BY: <br />FEVIEW: <br />APPROVA <br />''�This total must be paid before building permit is issued. <br />DATE .�-L< %(� <br />DATE -i- : - %, <br />DATE �'� �"���� <br />� <br />