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� . `• . 11 • - ! ' ' � � • ,� '' . .
<br />�
<br />BUILDING PERMIT TNFORI�SATION
<br />� � _ . �' ���< ;� '� , p
<br />ADDRESS ' �'./ - /', c%C ,. ;'� ,
<br />TYPE OF BUILDING
<br />1) BUILDING PERMIT FEE
<br />(A) PLAN CHECK FEE
<br />2) WATER SERVICE TO BE PAID BEFORE BUILDING
<br />PERMIT IS ISSUED
<br />3)
<br />(A) TO BE DETERMINED BY PLBG. INSP. i�7/ INCH
<br />(B) EXIST. WATER SERVICE, APPL. NO.
<br />(C) LOCATION es+Fi''_ �. ,.�:. 7- �i',1ii✓ --';�/�.r-' %!".��->- Q���i
<br />��/_�i ���� �.'�•'if /%!_ CHART GC-'- �
<br />i��
<br />DRIV�WAY PERMIT TO BE PAID BEFORE BUILDING
<br />�ATE '� - ;�'- ��_
<br />, ,. . —
<br />$ ��`".,
<br />$ 7 � � `"�;.'�
<br />$:,
<br />.,� i �, �';. C;
<br />PER_MIT IS ISSUED ' i S FT. ; ; `;'rl,', i. j D/W (TYPE) � I � � � " � ; ! :=
<br />-- cjC�
<br />. r,oT L�. � C} 3Q, �
<br />4j STATUS OF SEWER CHARGES: {�� � i�Zlll7��
<br />BOATL) ,1'�- DISTRICT _� �4�- FOOTAGE
<br />N, S, E, W.
<br />LANDSCAPE i�IOTES
<br />� �� - . . �:_ i. � ; _;
<br />� L.�,� c_. � __
<br />SEW]�R CONNECTION CHARGES:
<br />TRUNK
<br />LATERA7�. `
<br />� , .
<br />TOTAL GOJ�TN�CTION�;Hl�RGE
<br />SEWER PERMIT F�E
<br />CATGH BASIN PERMIT FEE
<br />( GI S G°ti
<br />� ,� ,
<br />$ � � r�'
<br />$ �. c� � c�-,
<br />� �%_7"`_'�-
<br />< `
<br />� � �; _ ,
<br />�_ � r
<br />TOTAL SEWER PERMIT FEES $
<br />5) MONTHLY �EWER CHARGES:
<br />SEWER CONSTRUCTION;
<br />TRUNK
<br />LATERAL
<br />SFWER SERVICE:
<br />?._ , , _'�
<br />$ � l,(,;;-
<br />$ , J; (�-
<br />LOCATION OI' SIDE SEWER OR T�E IN THE MAIN: CHART 5' -.� -�.i• - �
<br />;�jvr„- �T> 71�+ it'�S� r�L 'f/;': ��i," i�i�'i��rN (�i� I�I. i� ��li :°/�• ..i S.�ci,
<br />;, o.�., _ i ... . . �, . ,
<br />1_�/�;'1:.��;C "� � � �i'.)lr�f i � ;-r 1 _ l,�L� - . . . . . . , . .
<br />INFO COMPILED B
<br />REVIEW:
<br />APPROVAL:
<br />,, �,�,
<br />�
<br />DATE /--/,�� /;
<br />DATE �' � —�
<br />�N � ,.
<br />DATE � �I
<br />TMENT
<br />'�This total must be paid before building permit is issued.
<br />
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