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i <br /> � <br /> � �` i <br />�:.. <br /> BUILt�iNG P€RMIT INFORMATII�N � <br /> ly'. � ' <br />�V . . <br /> I <br />�' ADDRE55 � ol l (1 " l� - ,� � �� S� TYPE <br />�+`�"- (1) BUILDING PERMIT FEE 5 S G� �'—d <br />'" (A) PLAN CHECK FEE 3�� `fD – �& �, dS < 3S <br /> (n / — <br />�°_J°, (2J PLUMBING . � n`� <br /> (3) MECHANICAL �/�"` `� <br /> � (4) WATER SERVICE TO !3E PAID PRIOR TO BUILDING PERMIT ISSUANCE loSO� <br /> 3 � " <br /> (A) TO BE DETERMINED BY BLDG INSPECTOR _ �4 INCH <br />'` (B) EXIST. _ WATER SERVICE, APPLICATION NO. ___ <br /> (C) APPROX. LOCATION <br /> ; <br /> � <br /> 4:.,. �HART <br /> t�'` � (5) DRIVEWAY PERMIT TO B[ PAID PRIOR TO BUILDING PERMIT IS- <br /> � ` � oa <br />. SUANCE FEET DRIVEWAY(TYPE) S zC7—' <br /> � <br />::+; : . b <br /> ij����."'. i <br /> p) STATUS OF SEWER CHARGES: <br />;;: ; BOND � DISTRICT FOOTAGE <br />�:'..' N, S. E, y�' <br /> e: r; <br /> NOTES <br /> fTi,; ! / p S� <br />�`E-.-;, �� O <br /> �Y� /� 7�— fS <br /> s e�,�.., 3�r��, or <br /> (,�Jc� {t/' / %G•� <br /> � L� � '-�S� <br /> � 3 ?i0 Ad .-''� <br /> � �f/D r3o,v� C1✓A2�� <br /> � <br />, SEWER CONNECTION CHARGES <br /> � L YEAR TRUNK b Px� <br /> e S�w��e { l/•�4�E2 LATERAL <br /> : �� �-�c �y �,f Sa TOTAL CONNECTION CHARGES S � <br />- ��j ,�p � <br /> �(�f`/��D / �� � �,� SEWER PERMIT FEE b 3d� <br /> � Gv� `��` � � CATCH BASIN PERMIT FEE <br /> �SUpO l.�ia.2u� <br /> TOTAL SEWER PERMIT FEES 5 3 � 4� <br /> � (7) MONTHLY SEWER CHARGES: <br /> � <br /> SEWER CONSTRUCTION TRUCK b <br /> LATERAL <br /> SEWER SERVICE <br /> APPRCIX. LOCATION OF SIDE SEWCR OR TEE IN THE MAIN: _ <br /> CHART <br /> INFOCOMPILFD BY: _ DATE <br /> APPROVAL: DATE <br /> uei <br />