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_ --� <br />�nnREss <br />TYPE OF BUILDING <br />BUILDING PER\1IT I�ii'OR�IA'LION <br />�-�' — .�> � �'�� <S;� �. C' `< <br />J, <br />1) I3UILDING PERhIIT FEE � - ��U� � <br />(A) PLAN CHECK FEE <br />Z) �VATER SERVICE TO BE PAID BEFORE BUILDII�'G <br />PER\IIT IS ISSUED <br />(A) TO BE DETER.�INED BY PLBG. INSP. �� INCH <br />(B) EYIST. WATEti SERVICE, APPL. VO. _ <br />(C) LOCl� TION il' ' L�, .� . C�/�% ��i°,i %�� �-S. t'7�' C?� <br />-,_ r4 ' � � f�'C�:QxT Lu -? 7 <br />� / S,: s, c� . �%'�'/lc� � .�.�n. /�" <br />3) DRI�'Eti�''AY PER�SIT TU SE PAID BEFORE BUILDING <br />PER\IIT IS ISS�JED �� FT. /�l�ei:' /�Q'lT' Dl�;' (TYPE) <br />DATE <br />��5 /��I. ac� <br />��� !r 9. S`v <br />�%Qj , C9C,:� <br />� � <, . <br />—_- �___ <br />�� - <br />; � L, <br />� ��x , , <br />. TOTA T��j� � �i 4 <br />4) STATUS OF SEWER CHARGES: {`S�pl`71� <br />I30ND_�� DISTRICT G� ,� FOOTAGE � S E, ',V, <br />L��DSC�PE NOTES <br />CT,�-,'�-s u,�-rF--r. l_Gi,:�;::c;,._;=� �.:�� <br />,, 5?, - � Z[9U <br />_ �� C? <br />y Z`g ��°� � <br />� . f? U <br />SE�VER CON\ECTION CI-L�RG S � . <br />Tzu��� 7��7� � FG�. �=� �' _ <br />LATEkAL $ —�—� <br />TOTAL CONNECTIO:V�� R�� <br />SE�ti ER PERMIT FEE G <br />iCATCH BASIN 1'ER\-IIT FEE <br />TOTAL SENER PERMIT FEES <br />5) MONTHLY SE�VER CHARGES: <br />SE�1'ER CONSTRUG'?'ION: <br />i <br />S /�C�� , C?Si <br />$_Scl,A�� �� _ <br />S � <br />� JO. d CJ <br />TRUNK $ � � S <br />' LATERAL <br />SEWER SERVICE: J'� <br />F� � <br />LOGATION OF SIDE SE�VER OR TEE IN THE MAIN: CHART __ <br />1 �� - <br />G7:•,/7%%�1,� c�.�. /, + ��/ /Q����,1�1 /���r ;'L��'/,_-_� %� li.� <br />INFO CO\SPILED BY: <br />REVIE�V: //� / <br />APPROVAL: <br />�, <br />This total must be paid before building perinit is issued. <br />�A <br />� � ci.� <br />�� <br />.� <br />i - A � � <br />DATE ,S -/�=_ <br />DATE �/� ir> <br />DATE `S �li—%� <br />