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BUILDING PERMIT INFORMATION <br /> ADDRESS � 0?� S H Q�� S� t' TYPE�� � �«'y �� <br /> (1) BUILDING PERMIT FEE � �0�6d'b� 5 �� <br /> (A) PLAN CHECK FEE Pd M ���73 � <br /> S�J � d� <br /> (2) PLUMBING �.� �—� - <br /> (3) MECHANICAL LQ � •DO <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSI?ANCE <br /> (A) TO BE DETERMINED BY BLDG INSPECTOR INCH <br /> (B) EXIST. WATER SERVICE, pPPLICATfON NO. <br /> (C) APPRdX. LOCATION __ <br /> _CHART - - <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- ZQ �ov <br /> SUANCE FEE? DRIVEWAY (TYPE) S <br /> 5 <br /> p) STATUS OF SEWER CHARGES: <br /> BOND �� DISTRICT FOOTAGE <br /> N, S, E, W <br /> NOTES <br /> rJ�7CJ!�L uT1l.l l'7r �"' <br /> �> [I?I- 85"" <br /> y.y p t�q,c�D <br /> �r-a.,,a�� d-� <br /> � ��''' <br /> SEWER CONN�TION CHARGES <br /> YEAR � TRU!'JK S �QO�— <br /> LATERAL <br /> TOTAL CONNECTIC'N CHARGES � 3��� — <br /> SEWER PERMIT �EE s � � � — <br /> CATCH BASIN PERMIT FEE � —• <br /> TOTAL SEWER PERMIT FEES b — � <br /> (7) MONTHLY SEWER CHARGES: <br /> SEWER CONSTRUCTION TRUCK s <br /> LATERAL —•- — <br /> SEWER SERVICE <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: — <br /> CHART <br /> �.. <br /> INFO COMPILED BY: DATE <br /> hPPROVAL: <br /> �ATE <br /> s�ea <br />