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� UILDING t'ERIV(i!T If� FOFtMATION <br /> ADDRESS <br /> TYPE �L.►�-�lda-'� ��' tr <br /> (1) BUILDING PERMIT FEE � -IO/�(9 $ — � �� <br /> ' (A) PLAN CHECK FEE �� <br /> �'{-r,�,.06 <br /> (2) PL'JMBING Z7� •S� <br /> (3) ��E�HANICAL (OD- l� D <br /> (4) WATER SERVICE TO BE PhID PRIOR Tn BUILDINC PERMIT ISSIi;�NCC <br /> (A) TO BE DETERMINED BY BLDG INSPECTOR �._.— IN�H <br /> (B) EXIST. WATER SERVICE, APPLICA'ii0�� NO. <br /> (C) APPROX. LOCATION -- <br /> CHART <br />'� (5) DRIVEWAY P[RMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- 2O• Ud <br /> SUANCE _FEET DRIVEWAY (TYPE) S <br /> S <br /> (7) STATUS OF SEWER CHARGES: - <br /> BOND � DISTRICT FOOTAGE — <br /> I N, 5, E, W <br /> NOTES <br /> c`�i,�tr��Y u-n�"�f � <br /> r�rz� u"1� -85� <br /> !-{�,O l"�.D O <br /> �''�'��- � �� ,� <br /> SEWER CONN CTION CHARGES <br /> � YEAR _. �� TRUNK $ ��'�'� <br /> LATERAL ��cy� <br /> TOTAL CONNECTION CHARGES $ ��~ L <br /> SEWER PERh11T FEE $ ���D <br /> �_� <br /> CATCH BASIN PERMIT FEE $ �� — <br /> TOTAL SEWEfi PERMIT FEES <br /> (7) MGNTHLY SEWER CHARGES: $ <br /> 5EWER CONSTRUCTION TRUCK <br /> LATERAL <br /> SEWER SERVICE <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br /> CHART <br /> INFO (:OMPILED 8Y: DATE <br /> DATE <br /> APPROVAL: <br /> s ea <br /> � <br />