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<br /> �. - .�.i'�/. - 1 .�.��� __ i��,�• '
<br /> ENGINEERING DEPARTMENT
<br /> - -�/��-` BUILD'tNG PERMIT INFORMATION
<br /> i
<br /> APDRESS ;/: I = ----`--'_-`. . . . TYPE .
<br /> 1) BUI;,DING PEFMIT FEE ' -� , $ ('-' '�. �� '
<br /> (A) PLAN CHECK I'EP $ �'��_„ ':- �i
<br /> �) WATEF SERVICE TO BE PAID BEFORE BUILDING ' -� -��
<br /> PERMIT IS ISSUED $ ��%��•���
<br /> � f��'_�t_,. 2_�1, �t�
<br /> (A) TO BE DETERMINED BY PLBG. INSP. ' • ' INCH � �,; `i ; � �:� ,r�-�
<br /> (B) �XIST. WATER SERVICE� APPL. N0.
<br />'� --
<br /> (C) APPROX. LOCATION .`=a � " " �• � �•
<br /> r � • _ �
<br /> �
<br /> ��,t, `"-� . _ , , • r , _ , � r�-:.._ � CHART _ I� '�j`
<br /> i
<br /> 3) DRIVLWAY PERMIT TOrAE PAID BEFORE BUILDING n � �,�,�,
<br /> PERMIT IS ISSUED '_��- FT. �' "`%� • D/W (TYPE) �� $ ,�i • "
<br /> �� . * S '1i0 r•�i�)
<br /> TOTAL
<br />�� 9) ST:�TUS OF S�NTER CHARGES:_ �'�' 3�� ,Iy'.
<br /> BOND�,,%�'C�. DISTP.ICT -a '' FOOTAGE �
<br /> N, S, E, W. •y j��17�
<br /> , �
<br /> �r:_.
<br /> NOT135 SEWER CONNECTION CHARGES : .
<br /> � ,.
<br /> YEAR TRUNK $% ;����•� �--
<br /> J ^_ .' - ��C� c 'C:� � j �//LATERAL,, � $ r�---�� '
<br /> �G� ' �2�J NE�� �C'//� �l� 7 .�"i� f')
<br /> TOmAL C N T ON CKARGE $ �+-"��
<br /> SES4ER PERMIT FEE $ ,�j rl• !Si'
<br /> CATCH BASIN PERh1IT FEE $ `
<br /> ' TOTAL SELtiTE:R PERMIT FEES $ � �'
<br /> �) ::�`:� ii`,Y SEL9ER CHARGES:
<br /> S�I4ER CONSTRUCTZON: .
<br /> TRUNK $ �? ��
<br /> LATERAL $ ��
<br /> ;;, �,�
<br /> SEWER SSRVICE: $ - -�
<br /> z�n';.�};, ?,��,�TION QF SIDE SEWER QR TEE IN THE MAIN: ^ �i' '� , " • -
<br /> , , ,, _
<br /> �- . .� , � -, .�- -
<br /> - --'`— '� , _, . . l,.i ,r,,_,r9. .-
<br /> . . . ..... , .� �
<br /> _ '�,• ''L _ _ . , CHART ;� _ %�'. �.,,�:. r:.
<br /> � �— � 'r
<br /> � '.:�� COTIPILED BY � - � DATE � ;`/�;
<br /> REF_�W: DATE
<br /> PROJECTS DIVISION
<br /> ��P.�_ .... , : DATE
<br /> ENGINEERING DEPRRTMENT
<br /> * .. . "�tnl must he oair3 ht�fnra hi,i7A;..�* ...,.-,.+: 4 , � . �.-,.�.A
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