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, DEPARTMENT UF CORAMUN(!S DEVF.LOPfAENT SEPVICES <br /> � YJ � II.� � �'�tl •.� 6 �IClY1T+.•1 � 1'iFo�M���� i�G <br /> TYPE _ �' �' � <br /> AUDRESS �7 Lo.'3.SOO�c'� g ��` •��lta_ 3�-�F <br /> (1) EsUILGINr PERMIT FEE �� �i_,a,, , ,_ _ <br /> (A) PLAN l"HE�K FEE ,��, o0 <br /> (2) PLUMdING __ !y. S� _ <br /> (3) MECNA.NIC/�L (��. �,v <br /> r,4) WA7EK SERVIt:E i0 BE PAID PRIOR TO BUILDING PERMIT ISSUANCE - <br /> '-� INCH <br /> (A) TO 8[ JETERMINEu 3Y BLDG INSPE�TOR � <br /> (B) EXIST. .___ �'h�ER SERVI�E, APPUCAI lON NC. <br /> (C) HPPROX. LOCATIUN �_��13a'-'�ta i`'� r�L '�'n�'�ari - <br /> �.or. <br /> �r ,cJ DF- � UJ Ge;`• � CHART G -/9-ZS-� <br /> (5) DRIVEWAY PERMIT TO l3E PAI[) PRIUR TO BU��DRIVEI AY(TYPE) 3 _2�' �� <br /> SUANCE FEET _._-- <br /> � — <br /> � (7) STATl�S OF SEWER CHARGES: <br /> BONU -� DISl�RICT _ FOOTAGE <br /> N, �, E, W <br /> NOTE$ <br /> r��.;�,���? D�/E/-�'�F'i�7c�7T �� <br /> o��.� 7/5-8 � <br /> /��...E�.� '2- <br /> + �-f='2. 33`�' vJ <br /> , � <br /> � <br /> � <br /> r. <br /> SEWER CONNECTI N CHARGES �33 � �U �' <br /> YEAR � TRUNK $ I <br /> LATERAL 3�� �� , <br /> j 1"OTAL CONNECTION CHARGES $ y � <br /> H � <br /> ' �' F <br /> S ��" �� � <br /> ! SE4VtR PERMIT FEE � � <br /> � CATCH BASIN PERMIT FEE � F <br /> � TOTAL SEWER PERMIT fEES � =-`3��� � � <br /> .� F <br /> (7) MONTHLY SEWER CHARGES: _ �` � <br /> TRUCK $ � � <br /> SEWER CONSTRUCTION � u <br /> LATERAL � <br /> o � <br /> '� r: <br /> SEWER SERVICE �� � ���r-; � F'. <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE NiAiN: �-._G�T—�---P�4=•--'��' �' <br /> c.,: <br /> ! ,r�c M. !./ `L` £�'i aPP.¢CX �F T Dr�."7> � /� _Z�._ 1 t�; <br /> � CHAP.T ` <br /> DATE _ <br /> INFO COM,PILED BY: _ <br /> DAT[ _ <br /> APPROVAL: <br /> 9 149 <br />