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� ENGINEERING DEPART6IENT � <br />BUILDING PERbiZT IPIFORMATION <br />ADDRBSS '''i �?._E ? -' •�t r1 rr I -- �i'°.f. TYPE � � fi ! <br />1) BUILLZ:I^v PEF.MIT FE� L�-0���. ` $/S�,�D <br />(11) PLAN CH�CF: FEE S _���5�_ <br />2) C:=1TBR �ERVICB �0 BE i�iiID BEFORE BUIL•DIidG <br />PEI2:dI`P IS IuSUED $ ? % "• "�-'� <br />(�/�, � Z� . o � <br />(A) TO IIE DETERtdINED BY PLIIG. INSP. _� IlvCfl N���+ , 1 p� <br />�3) �%ISi. ^--' L9r1TER SERVICE, APPL. N0. """` <br />(C) APPROX. LOCATION �i "r_ y •r � ( ' ='r �' ^�� ' <br />,', r ,;= t T i".� d' a <br />' CFIART ��,�- 7� <br />3) DRIb'BI4AY ?'ERti1ST TO BE PAZD BEFORE LUILDING <br />Pi:RtilIT IS ISSU�D �,.�3 FT. , r.> > D/W (TYPE) _ <br />4) STrITUS OF SET�7ER CiIARGES: <br />BOND 'F',f' DISTRZCT �C�'� FOOTAGE - �-•-- <br />— r <br />N, u, F, <br />�� u <br />$e+wng• Y 23 � �a.r�'f-,ej" <br />N� w. fi h. n ,(j ac i�.�'r�� s�i ows <br />orc �IAn�, <br />3! ZS' �S'l- -oo <br />TOTr1L* <br />. $—�� � �— <br />S �Col. Or� _� <br />SEIv'ER CONNECTION CHARGF'S: <br />YF:AR � ? i'. TR`JNK $ `l:� <br />;.�ti' <br />—�—._..- -- — <br />/JcF' � 9�Z ��a�L s � r 2.. .s-� <br />TU^1AL COiJ EC IO C;ii:FiG� S S�% %. �"�_ <br />S�WER PERI�IIT FEE <br />CATCH IIASIN PEIL•;IT FE� <br />I ; TOTAL Sli�9ER P�:tf•1IT FEES <br />5) [:O;ITHLY 5��9�R CHe�RGES: <br />--- � <br />SL[�'ER COKSTRUCTION: <br />TRUIJF: <br />Li,^1 ERAL <br />SE�•7�R SERVSCE: <br />[,PPPO:{. LOCATI0:1 OF SIDE Sr�•TLR OR TLE IN T!IE ILAIh': <br />1�.. �:_,...� ,�.rw, " y ei 'L T 2� df.V4�. A'E1 /�ti_ �. Frra <br />I^?l'0 COh1PILED DY: <br />R�VIEi9: <br />~ PkOJECTS DIVISIG:V <br />A?'P RO i�AL : -.--.— <br />----- .'?:G16P _3i!d� DPPIR'i`PL''.lvT <br />„ r.- o <br />�i .7'.i <br />� <br />$--- �O /�0 <br />S z. A,r <br />$ _?��__ <br />n • <br />ma,n in eesrn;,•* �S'2••o ' <br />r 5 2 n° F'/ �+a! <br />—(3 _'S-Z�-� — <br />DATE 4- �.�- 7� <br />DA'PE <br />DATE <br />* This total must be Pa:.d before buildinq pernit is issued. <br />� W � i t <br />