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ENGINEERIN� �EPkRTMENT <br />_ BUILDING PERMIT INFORMF�TION <br />��� � ^ <br />ADDFi�SS SC-.���I %�'� ���/. TYPE_ :� i" fi <br />1) BUILDING PERMIT FEE <br />(A) PLAN CflECK FEE <br />2) WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />a <br />$ "GL-2./•L2�/ <br />(A) TO BE DETERMINED BY PLBG. INSP. -�'�__ INCH <br />,�_ <br />(B) EXIST. WATER SERVICE, APPL. N0. __ <br />(C) APPROX. LOCATION('% �o �� C./. Z�' °v � ,S�fg� <br />� (O �� G.I • Z,3 � L{/. � .�:3 � %7�//� �'i� CHA.RT � <br />3) DP.IV�WAY PERMIT TO BE PAID BEFORE BUILDING ,_ <br />PERMIT IS ISSUED �; � E'T. =< i ' �- D/W (TYPE) $ , '. -' <br />TOT�1L* <br />4) "TATUS OF SEWER CHARGESa: �/ <br />BOND� DISTRTCT �i3 FOOTAGE '— - <br />N, S, E, W. <br />�� - Z 5' `^ �� �"�U _ O U <br />SEWER CONSTRUCTION: <br />SiWER SERVI�E: <br />APPFOX. LOCATION OF SIDE SEH <br />_ ,�/�. �—�� <br />-�— <br />IN 0 COMPI ED BY: / it._,; <br />U <br />RFvzEw: <br />? OJEf. <br />� � <br />APPROVAL: / <br />SEWER CONNECTION CHARCES: <br />YEAR �� _ TRUNK <br />LATERF,I� <br />TOTAL CONNECTION CEARGE <br />SEWER PSRMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />TEE IN <br />M��)�I <br />DEPARTt4ENT <br />TRUNK <br />LATEF;AL <br />MAIN: <br />� � <br />* ��p'..;.- Fnh_,I .�,�e+- 1.., ..�:a l..,c...-.. �...,,...._ . ---' <br />$ <br />$ �/'J�•f�� <br />� --- <br />� /��'- c� <br />s ��r'O <br />$ �___ <br />s �.�,0 <br />s: - a-.�� -, <br />DATE �y� Z/o= <br />DaTs <br />DATE �f .��1 .�' <br />