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I • � <br /> DEP....fMENT OF COMMUNITY UEVELOPMEN. SERVICES . <br /> � �11L71NG P� �I�111' dNF��R�t�AT'�0�1 <br /> . . <br /> ADDRESS �� �DT,G� .L�v� �•�. ___TYP[ �' ��• <br /> (1) BUiLDING PERMIT FEE $57j 5pD • �V � � 7•Oa <br /> (A) PLAN CHECK FEE p'�'# 5�� �`� <br /> (2) PLUMBINC o7,�' • D O <br /> (3� MECHANICAL �Z 2• 50 <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDING FERMIT ISSUANCE _ ��' �� <br /> (h) TO BE DETERMINED BY BLDG INSPECTOR � INCH <br /> (B) EXIST. WATER SERVICE, A�PLICATION NO. <br /> (C) APPROX. LOCATION 8� c•� N+��� �PP�h- Z'd"` C o'� <br /> �� �P� y',tD or� S.w co� Go-� <br /> � � ��w; s�cuf�P�t� � CHART�4 C� <br /> (5) DRIV�.✓AY PERMIT TO BE PAI� PRIOR TO BUILDWG PERMIT I�- <br /> SUANCE 25 FEET G�tiG DRIVEWAY(TYP[) $ l2 • 50 <br /> S �� <br /> (7) STATUS OF SEWER CHARGES: Pa • O <br /> BONU -L�T' DISTRICT 3S FOOTAGE <br /> N, S, E, �N <br /> NUTES <br /> OL�n 2 <br />� o,2ao ��2 -8 a <br /> � 33�. � <br /> f <br />� <br /> i <br /> i � <br />� SEWER CONNECiION CHARGES �.�� <br />, YEAR --�'� � � TRUNK $ ����� <br /> f LATERAL �� � <br />( TOTAL CONNECTION CHARGE S �8 <br />� �.��� �I <br /> SEWER PERMIT FtE .3I/�I $ 30•�1a <br /> I CATCH BASIN PERMIT FEE j�" <br /> ITOTAL SEWER PERMIT FEES �'�,.�'� $ -�' �D _ <br /> I <br />` (7) MONTHLY SEWER CHARGES: <br /> j SEWER CONSTRUCTION TRUCK � 2' 2� <br />� LATERAL �' <br /> SEWER SERVICE 5. / O <br /> APPROX. LOCATION OF SIuE SEWER OR TEE IN THE MAIN: S� M/s«�� v 2 uJ� �-�j <br /> �--� P�j�- r�PP2ca.. li�r� �( 'D� M U 2 �' /�-PP29x laP-r ��� er <br /> I PI� CHART � I�J' 25-5 <br /> I�I INFOCOMPILED BY: DATE <br /> i APPROVAL: �ATc <br /> �-ia�� <br />� - - <br />