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�r <br />a <br />ILI <br />ADDRESS <br />4 TYPE OF BUILDING <br />UUlLL1:VU YLxI\711 11VD Vx1b7H 11V 1� <br />1) BUILDI\'G PERMIT FEE <br />(A) PLAN CHECK FEE <br />z�c�s4 . as <br />2) WATER SERVIS ICE <br />FE PAID BEFORE BUILDING <br />DATE <br />S IZi•`= <br />(A) TO BE DETERMINED BY PLBG. INSP. INCH <br />(B) EXIST. N WATER SERVICE, APPL. NC. c �o� wo <br />(C) LOCATION Tle�UT/e/ <br />F,L�aMSCUa`X4 W74 �CST%�!L%lr_i 337T/oYj H4RT_ �" <br />3) DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING 0�� SQ <br />PERMIT IS ISSUED � FT. D1tY (TYPE) QJ�% <br />TOTAL'`'' �� _ 1, <br />4) STATUS OF SE\CER CHARGES: SG"Zvee /YOT /I1w(I. 41ei f— <br />BOND DISTRICT FOOTAGE <br />ti, S, E, 1C. <br />l SSC169 ,0 51va('10M,s1l f!X//// Wr oK -q a I- 7s <br />LANDSCAPE NOTES (SEWER CONNECTIC\ CT.-1ARGES: <br />TRUNK S <br />LATERAL S_ <br />TOTAL CONNECTION CHARGE S_ <br />SEWER PERMIT FEE S_ <br />CATCH BASIN PERMIT FEE S__ <br />TOTAL SEWER PERMIT FEES S_ --- <br />5) MONTHLY SEWER CHARGES: <br />SEWER CONSTRUCTION: TRUNK $ <br />LATERAL <br />SEWER SERVICE: $ <br />LOCATION OF SIDE SEWER OR TEE IN THE MAIN: CHART <br />INFO COMPILED BY <br />REVIEW: <br />APPROVF <br />`This total must be paid before building permit is issued. <br />DATE•%/Dy,Z/(�- <br />DATE4'�"__ <br />DATE 7-t'°"7j� <br />