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DE�ARTMENY OF COMMUNITY DEVElO►MENT SERVICFS <br />BUILDING PERMIT lN�OR11�arTION <br />ADDRESS �°�/ � �� 6`'``�`' �, TYPE SF R <br />(1) BUILDING PERMIT FEE yS 000�% g o2G0' <br />(A) PLAN CHECK FEE '�- <br />(2) PLUMBING a`'� � <br />(3) MECHANICAL �S <br />� <br />(4) WATER SERVICE TO 8E PAID PRIOR TO BUILDING PERMIT ISSUANCE � � <br />(A) TO BE DETERMINED BY BLDC INSPECTOR 3�� INCH <br />(B) EXIST. WATER SERVICE, APPLICATION NO. <br />(C) APPROX. LOCATION <br />CHART <br />(5) DRIVEWAY PERMIT TO BE PAID PRIOR TO UILDING PERMIT IS- �, � <br />SUANCE o�1S� FEET DRIVEWAY(TYPE) ! �d <br />5 3��__ <br />(7) STATUS OF SEWER CHARGES: <br />BOND _ � _DISTRICT <br />NOTES <br />N <br />FOOTAG E <br />N, S, E, W <br />t <br />SE4VER CONNECTION CHAFiGES � <br />YEAR ��- TRUNK b a 70 <br />I.ATERAL �- <br />TOTAL CONNECTION CHARCES b a 70 � <br />a+- <br />SEWER PERMIT FEE � -�� - <br />CATCH BASIN P+�RMIT FEE � - <br />TOTAL SEWER PERMIT FEES b 3� <br />(7) MONTHLY SEW[R CHARGES: <br />� SEWER CONSTRUCTION <br />� <br />� <br />� <br />"fRUCK b <br />LATERAL <br />SEWER SERVICE <br />APPROX. LOCATION OF SIUE SEWER OR TEE IN 7HE MAIN: <br />INFO COMPiLED BY: <br />APPROVAL: <br />9�1�79 <br />CHARTL ��-��' `� <br />DATE <br />DATF <br />i <br />