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r] 1 <br />FOR OFFICE USE ONLY <br />ADDRESS <br />(1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />(2) PLUMBING <br />(3) MECHANICAL <br />(4) STATE SURCHARGES <br />(A) BUILDING CODE <br />(B) ENERGY CODE <br />(5) DRIVEWAY PERMIT <br />(6) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br />(A) TO BE DETERMINED BY BLDG. INSPECTOR C2 <br />INCH <br />(B) EXIST. WATER SERVICE. APPLICATION NO. _ <br />(7) STATUS OF SEWER CHARGES: <br />BOND DISTRICT _FOOTAGE N. S. E. w <br />Ag 9 ' X �/ 40 <br />/oo44: <br />SYSTEMS DEVELOPMENT <br />WATER <br />SEWER <br />TOTAL ORD. FEE <br />SEWER CONNECTION CHARGES <br />YEAR TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGES <br />SEWER PERMIT FEE <br />s <br />s <br />s 10 <br />7q <br />I '200 0 0 <br />