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•�- I <br /> I <br /> DEPARTM[NT OF COMMUNITY DEVELOPh7ENT SERVlCES i <br /> 8 �+ � �.� a �c PERn� s�r or� Fc��n���iorv � <br /> �a <br /> ADDkESS � ` �� ���'n'� 5.�• TYPESi�LE � �� � <br /> M/L`� CS <br />, <br /> (1) BUILDING PERMIT FEEY''0� 6161�•� S �-��• �� J <br />� (A) PLAN CHECK FEh: � � ���� .;1'� <br />� (2) PLUMBINC Q •d� '=j� <br /> (3) MEC,iANiCAL �C' '�D I '`� <br /> �,:� <br /> (4) WATER SERVIC[ TO 5E PAID PRIOR TO BUILDING FERMIT ISSUANCE ��'�%� � ,,�,� <br /> (A) TO BE DETERMINED BY f3LDG INSPECTOR _�� INCH � ' <br /> i >.-�+� <br /> (B) EX157. _ WATER SERVICE, APPLICATION NO. I =a <br /> (C) APPROX. LOCATION��P.�E�T� �L _t_sF'P�OK �I �''r I ��'� <br /> I s; <br /> ;G� <br /> �n.I oP IV C.oN 0� I.pf CHART L� 18.. �/J�,�_ S' ';�,� <br /> -7.. <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO DUILDING PERh11T IS- ' �` <br /> SUANCE FEET DRIVEWAY(TYPE) S �a.OG `'�r� <br /> S <„ <br /> I ; <br /> (7) STATUS OF SEWER CHARGES: . I � <br /> OOND � DISTRICT FOOTAGE I .'� <br /> N, S, E, W � <br /> NOTES <br /> s�i a� s�wse c��Q�.� <br />� c�r� ll`z!-�� <br /> -�t �.t�,tt.�� ��( . ��.� <br /> � a � �4. 00 'I <br /> �..��� Z • � p <br /> � CiOS p' BSEW[R CONN[CTION CHARGES <br /> . . � Y[AR ��P TRUNK S 330•Ba ' <br /> LATERAL ! <br /> TOTAL CONNECTION CHARGES $ _ 330•�� '� <br /> SEWER PERMIT FEE g .30•�0 <br /> , CATCH BASIN PERMIT FEE <br /> TOTAL SEWER PERMIT FEES S 3�'�� ' <br /> (7) MONTHLl' S[WfR CHARGES: <br /> SEWLR CONSTRUCTION TRUCK $ <br /> LATERAL <br /> SEWER SERVICE — <br /> APPROX. �OCATION OF SIDE SEWER OR TEE IN THE MAIN: '�"�7�1F3�'� Tc� PIL-. A(�'LGtI�' <br /> , � � �-' OF I�rW GAI� B4� L6T �. �PPRB�C 4 FT t��� AT <br /> ��t,... CHART L'� «'"ZS' S <br /> T!_ <br /> IN�O COMPILED DY: DATE <br /> APPROVAL DnT[ <br /> s-ea <br />