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r3UILDING PER\-iIT INI'ORIvfATION <br />... > i; a, � <br />ADDRESS .���,3� G .✓I�� <br />TYPE OF BUIL?�ING^ � PG�%� DATEJ ��-�j <br />1) BUILDING PERMIT FEL $ ��. <br />(A) PLAN CHECK FEE $/Z/• C� S <br />2) V�'ATER SERVICE TO BE PAID BEFORE BUILDING <br />F'ERMIT IS ISSUED <br />iA) TO BE DETERMIIQED B�' PLBG. INSP. INCH <br />// <br />(B) EXIST. I L �5'ATER SER�'iCE, APPL. NO. �OJ <br />(C) LOCATION //�7'(� SO. ,��G <br />—J <br />CHARTS -SI <br />3) DRIVEIVAY PERMIT TO BE PATD BEFORE BUILDING <br />PERh4IT IS ISS�JED FT. D/�t' (TYPE) <br />. 0 Fr �LG ��, <br />TOTAL� <br />4) STATUS OF SE15�ER CFiARGES: N4��N F=�"� <br />BOND__ DISTRICT FOOTAGE <br />N, S, E, W, <br />LAIQDSCAPE NOTES <br />SEl'� ER CONNECTION CHARGES: <br />TRUNK <br />LATERAL <br />TOTAL COA'NECTION CHARGE <br />SE�t'ER PERN.IT FEE <br />CATCH BASIl� PEP.MIT FEE <br />TOTAL SE�YER PERMIT FEES <br />$ <br />$ <br />S, � <br />�, <br />� <br />� <br />5 <br />5 <br />� � 3v, U c� <br />� $ /D. U U <br />� � 5<Cj, d�� — <br />5) MONTHLY SE�VER CHARGES: , <br />SEWER CONSTRUCTION: <br />TRUNK $ <br />� LATERAL $ <br />SEWER SERVICE: • $ /�'I�'%�,Q,�D <br />LOCATION OF SIDE SEWER OR TEE IIQ THE MAII�': CHART ,�-�(j -„Z�j�� <br />.SCcc�e�,t' �.4��..°,�J /S�/ �,2a�c�i Y��6,Pi�'y Si 2.i I NI�9iiv ini elii� s� <br />c� "I Id�f',f ,`� % � <br />INFO COMPILED BY <br />� <br />REVIEW: /l. L <br />�^ <br />����� <br />APP OVA � <br />F <br />� <br />'/Ila. ��' <br />Lr� <br />�`This total must be paid be!'ore building permit is issued. <br />/, <br />DATE S— <br />Dr,TE .3 ,20 7�� <br />DATE�2? %� <br />___,.w-�-- __l'� � <br />