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�30� ��t� <br />ADDRESS � � <br />� <br />1) BUILDING PBRMIT FEE <br />(}�) PLAN CHECK FEE <br />ENGINERRZNG DEPARTMENT <br />r.nTu[; Pt.RMIT INFORMATION <br />� S� . <br />��[,J <br />"j,S", Z J ZT <br />2) WATER SERVICE TO BE PAID BEFORE E�UILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETEF2MINED BY PLBG. INSP. �/< INCH <br />r��, �� <br />� �iy� <br />-�/-- 5l�c <br />TYPE �%%'t'! G-"� <br />$ / 5 y, ,. _, <br />$ -- <br />(B) EXIST. WATER SERVICE� APi'L. D10. _ <br />((;) APPROX. LOCRTION �� � � �• , 2� , �' � <br />�-j-� ;�ry�; CHART fV "4�� <br />I <br />3) DRZVEi4AY PERMIT TO BE PAID BEFORE EUILDTNG <br />PERMIT IS ISSUED `fT. '� D/W (TYPE) <br />�(j � "�LL E � TOTAL* <br />4) STATUS OF SEWER CHARGES: � � <br />BOND --- DISTRIC^i --- FOOTAGE�'L���Li+�-�-''^`i� — <br />N, S, E, W. <br />J S��+TP.R CONSTRUCTION: <br />SEWER SERVICE: <br />APPR04. LOCATICJN <br />��! ��J' � .L<r''_� <br />INFO CODiPILED BY: <br />SEWER CONNECTION CHARGES: <br />YEAR �_ TRONK <br />LATERAL <br />TOTAL CONN£CTION CHARGE <br />SEWER PERMIT FEE <br />CAT�H BASIN PERMIT FEE <br />TOTAL SEWER PF.Rb1IT rEF.S <br />SIDE SEWER OR TiE <br />✓ f�1_/ �7/ � . � <br />TRUNK <br />LATERF�?. <br />�AIN�.�, r�< <br />$ . ��� �, / f'; <br />$ G, �s_ <br />S 3,5 �f <br />i� <br />�" DATE <br />REV I E�9: <br />PROJECTS DIVISION <br />DATE 3'.i�r�' L�fL---- <br />APPROVAL: � <br />NGINEERING DEPARTMENT <br />* This total must be naiA 1,afnrA h+��i��^^ ^^^^ <br />: a . . .. . ...... ...a <br />