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ENGlIIECJtING AHD COfil-WHI•TY SERvicl-s <br />DUILDIIIG PEW47T INFORMATION <br />ADBRL:SS t�'�,Lw Ti- <br />1) BUILDING PERMIT FEE s���pmiaG <br />(A) PLAN CHECK FEE <br />2) PLU1I3ING <br />3) MECHANICAL <br />4) WATER SERVICE TO 13F PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(A) TO, BE DETER14INED BY PLBG. INSP. 2 INCI1 <br />(B1 EXIS'T. WATER SERJICE, APPL. NO. <br />(C) APPROX. LOCATION 2011 IO LllV1%A^nd m <br />CHART <br />5) <br />DRIVEj9AY <br />PERrLI•T <br />TO BE PAID BEFORE BUILDING <br />PERMIT IS <br />ISSUED '2-S T A S fI _ D/L7 (TYPE) <br />6) <br />STATUS OI <br />-SOIEP. <br />CHARGES: TOTAL $ <br />BOND DISTRICTS <br />NOTES <br />7) "IONTHLY SEVER CHARGES: <br />FOOTAGE ^ (J <br />� <br />SEWER CONNECTION C1iArZ)]v <br />YEAR 5Z. <br />' LATER117G„%11In31$/) S��• off-. <br />TOTAL CONNECTION CIIARGE: 1IC9B <br />SE'YER PERMIT FEE $ <br />CATCH BASIN PERM gFEE�$ _ <br />TOTAL SEWER PERMIT FEES$ J Oa <br />SEDER CONSTRUCTION: TRUNK $_ /5 <br />�64- <br />LATERAL $ ff�tts� p <br />SEWER SERVICE $ emc- <br />APPROX. LOCATION OF SIDE SC11E3 OR TEE IN THE MAIN: C�gl vy 6 r- ' <br />INFO COMPILED BY: <br />APPROVAL: <br />CHART <br />DATE <br />DATE <br />qo <br />�o C �6 <br />u <br />�1 <br />