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���w�wenF°a��r� Raws�� -.�4 <br /> �_ r>�- ( U <br /> (;. . ;;L ILDI`:G :��::\Iil' iNI�Ci.\?A'I'I'��I f./�'T. Vit;(� f-� <br /> �'C , - ---- �... <br /> -�'�ar' ` <br /> � :�D?:'_?y�_ -z:�� - �o c'i�-l�r✓(.�f-5�,�''z„7 /� ' � �' ` t' ' c.-,� <br /> /'C� �• fr / %/ ��,� <br /> T1'PE Gs BUILDING ,� �� � D:1TE '7 <br /> -_:<� i'.J <br /> 11 �UILDI_VG PERi\4IT F�E �J=�,c��ci � ��� <br /> (�) PLAN CHECI{ FEE �—���� - <br /> ?1 �t"-1T�R SERVICE TO BE PAID B:FORE BUILDIPdG <br /> PER\;IT IS ISSUED i� � <br /> ( � ' � r <br /> (-�) 'r0 BE DETER�L�;ED B1' PLEiG. ITQSP.�_ INCH <br /> -r. v:,� <br /> B) E?XIST. '�YATEt2 SERVICE APPL, i�TO, � • y��'�;l <br /> (C) LOCATION L1��, fjr%� �0 �" �� � /�( 4� ,�, ��.. <br /> � i�. <br /> � rSiIC'/s UF C�o�'�; � c�axT .5��.� ,'/ <br /> � i DRI�-z�','A`I PEF\tIT TU BL P:�ID IIEFUR� BliILDI�iG <br /> P�R�;IT IS I557ED '��.i FT. �?n,4��'Q-f'�4�i�1' (TYPE) � /c� �_5 �_J , <br /> TUTAL ; �.L-7, -� <br /> .! S7 aTUS OF SEIVER CH.4RGES;. �.� '-' S y���" r � ' -- -__— <br /> 'U'vD �� DI�TRICT J � FOO�AGE <br /> N, S, E, 1V, <br /> , -::DSC.=�PF. NOTLS ISE�1'ER CON\ECTIO\' CH.�RGF_S: , <br /> TRU�iK !; � <br /> ;� , . � ._�� <br /> LATERAL s �"--" <br /> TnTAT., CO�?NECTiO\ CII4P�GE S /��S . cl u � <br /> ,� SE\VER PERti1IT FEE $ �C_%_ L: �� ' <br /> ' CATCH BASIN PER�IIT F'Er, $ —'--� i <br /> ' ` TOTAL SE�YER PF,RMIT FEES S ���� - ��� ' � <br /> ! :1 �,fONTHLY SEWER CI-IARGES: <br /> r . <br /> ! SE«"ER CONSTRUCTION: <br /> i �� <br /> I TRUNK $ •�i � �j � <br /> LATERSL $ <br /> I SF.WER SEFVICE: � ��� �S CJ '� <br /> LOCATION OF SIDE SE�VER OR TEE IN TH� N1AIN; CHART / ' <br /> � i�'�/�f -���F-S — <br /> � �, � �, �,� ;� ,�., . <br /> _� / f'Sb/c� �li L ;'I�, f� y /i�� � ' S�'� i)F_1�I.i� %,;, �Z,4;�r <br /> � � <br /> ��� � .✓�I��Jx �,•' �� /�� ��� I <br /> IVFO CO\�fPILED B : �� `.�J� (�(�' — <br /> `2 �DATE ��-� �' 7 <br /> REVIEIV: ��j� /J c-t-z_1_ DATE � -�-� � , <br /> TRAE1 IC DIVISION <br /> AFPROVAL� ` �j�//f/�'l^-yt�o.�,. DA,�,� f Zj 7S <br /> _�iGIN ERING D�Yl1fZ'T'MEP;T <br /> � <br /> � �=This total mest b�� naici before buildin[; per�iiiL is is:sueu. <br /> � <br /> .�.__. ..��.� <br />