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i <br /> DEPARTMENT CF COMMUNITY i7EVELOPMF.NT SERVICES � <br /> � 6UILDING ��ttIV11T IN ��RMATl�?N <br /> /O(p/O /Dii1 D,� S L` TYPE s ' �� � <br /> ADDRE55 Q� ���, pU <br /> (1) HUILDING PERMIT FEE Lfl `l�� ' � - � <br /> '7� �v Duc _ I <br /> (A) PLAN CHECK FEE � ��� �U <br /> (2) PLUMBING .�Z �� <br /> (3) MECHANICAL -' �� 0� <br /> (q) WATER SERVICE 'f0 BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br /> (A) TO BE DETF.RMINED BY BLUG INSPECTOR INCH <br /> (B) EXIST. -- WATER SERVICE, APPLICATION NO. <br /> (C) APPROX. LOCATION � - ' T�' �'�L ���'GO� � F Y <br /> C nF �l•W �o�c. v,� Lor CHART �-' � 9-�g ��l <br /> (5) DRIVEWAY P[RMIT i0 E3E PAID PRIOR TO BUILDII�G PERMIT IS- 2 0 �C� <br /> � SUANCE _ FEET DRIVEWAY(TYPE) � <br /> ' S <br /> I p) STATUS OF SEWER CHARGES: <br /> DOND �—DISTRICT _FOOTAGE <br /> N, S, E, W <br /> i NOTES <br /> ' ��[.� .�Q/�z.o���,��7" ,�� <br /> '; O,e�� 'i%5—g c� <br /> ,�lz� 2 <br /> ; ��� . 3�9• o� <br /> I c <br /> SEWER CONNECTION CHARGES 330-Oc7 <br /> YEAR <br /> �� TRUNK � �' <br /> � LATERAL <br /> ' TOTAL CONNECTION CHARGES $ '3-���� <br /> H � <br /> y �- <br /> SEWER PERMIT FEE $ 3� ��� � F <br /> � <br /> � - <br /> ' CATCH BASIN PERMIT FEE `�' � <br /> TOTAL SEWER PERMIT FEES $ ����� a r <br /> � , <br /> (7) MONTNLY SEWER CHARGES: � � <br /> TRUCK $ � � <br /> SEWER CONSTRUCTION � <br /> LATERAL - <br /> � <br /> SEWF.R SERVICE � . <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: L��' �T�'a""-" '�s`—�I�— - - <br /> Gco,G o,� Lo7 c{ ;, .,�„�„ s� r->� � <br /> [a �nvC. 3 r�� (.v JF � � _� <br /> � CHART L / �/ Z 8 � � <br /> �. <br /> c <br /> . - <br /> � <br /> INFO COMPII_FD BY: DATE _------ .- <br /> CA�f[ <br /> APPROVAL: <br /> 9-1-79 <br />