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" 1 ... ..1 ' . . <br /> . ' . . �liri. . .. '.nl ' ': }. . . . . ._ . . . � � . 'k <br /> DEPARTMENT OF COMMUNITY DEVELO►MENT SERVICES <br /> � � �ui �uiNc ��a�ir � �v �a�nnar�oN <br /> ADDRESS � � ,1D2,c>O �L, S. E, TYPE C�'�i/i��l . <br /> (1) BUItDINC PERMIT FEE �C''' J,�'D• �`�-- ; :��7'.'`.- �[� <br /> (A) PLAN CHECK FEE /-'cJ, F307-l� <br /> (2) PLi1MBiNG �� - °U <br /> (3) MECHANlCAL <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE �� • f'� <br /> , (A) TO BE DETERMINED BY BLDG INSPECTOR INCH <br /> (S) EXIST. WATER SERVICE, APPLICATION NO. <br /> i � (C) '�APPROX. LOCA,TION <br /> J ; .. ' . <br /> • , <br /> CHART <br /> (5) pRiVEWAY PERMIT TO 8E PAID PRIOR TO BUILDINC PERIvfIT IS- <br /> SUANCE FEET DRIVEWAY(TYPE) 1 <br /> S <br /> (7) STATUS OF SEWER CHARCES: <br /> . BOND �L pISTRICT FOOTAGE �� <br /> N, 5,� W <br /> NOTES <br /> �7.UE�Z T�-2�, �� <br /> �.erJ, //7/- �� <br /> SEWER CONN�,CTJQN CHARGES . <br /> YEAR �S TRUN{: S ��✓O QG� ' <br /> • � , : . � . . LATERAL �. �74, g Z <br /> . ' , � , ' •TUTAL CONNECTION CHARGES S �COU`,�.Z7i <br /> ,, �. . SEWER PERMIT FEE S •� ��� <br /> _ CATCH BASIN PERMIT FEE <br /> ' 70TAL SEWER PERMIT.FEES . 5 �'�� <br /> (7) MONTHLY SEWER CHARGES: <br /> . SEWER CONSTRUCTION TRUCK b <br /> LATERAL <br /> , SEWER SERVICE <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br /> CHART <br /> INF� COMPILED BY: � . DATE <br /> � APPROVAL: DATE <br /> ' r^ <br /> • . i ' ) <br /> ai•i9 i ' <br />� <br />