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DEPARTMENT OF COMMUNITY DE4ELOPMENT SERVICES <br />BUILCiING PER.lNIi' iNFORMAi'10N <br />ADDRESS �y �� �� �'� �� _TYPE `� F � <br />$ . 02-3 � � <br />(1) BUIL!�ING PERMIT FEF �_ <br />(A) PLAN CHECK FEE �o .' <br />(2) PLUMBING �s � <br />(3) MECHANICAL - % <br />(4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PFRMIT ISSU/1iJCE �� <br />(A) TO 8E DETERMINED E3Y [31.DG INSPECTOR ��� INCH <br />(B) EXIST. W�TER SERVICE, APPLICATION NO. <br />(C) APPROX. LOCATION _ <br />CHART <br />(5) DRIVEWP,Y PERh11T TO BF PAID PRIOR TO BUILDING PERMIT IS- `o <br />SUANCE — <br />F[�T DRIVEWAY(TYPE) S �� <br />� <br />(7) STATUS OF SEWER CHARGES: <br />HOND _-DISTRICT _ FOOTAGE <br />N, S, E, �' <br />NOTES <br />SEWER CONNECiION CHARGES <br />YEAR TRUNK <br />,� <br />LATERAL � � <br />TOTAL CONNECTION CHARGES <br />S[WER PERh11T F[F <br />CATCH BASIN PE�MIT FEE ��i�� / <br />TOTAL SEWER PERMIT FEES <br />(7) MONTfiLY SEWEft CHARGES: <br />SEWER CONSTRUCTION <br />3 � <br />$_ o <br />o� <br />$ 3 6 '_ <br />TRUCK 5 <br />LATERAL <br />SEWER SERVICE <br />APPROX. LOCATION OF SID[ SEWER OR TEC IN THE MAIN: <br />iNFO COMPILED BY: <br />APPROVAL: <br />n i.?y <br />CHART L ��"`��- y <br />DATE <br />DATE <br />�y r <br />� �. <br />H� <br />�' c <br />o� <br />h� <br />� <br />� <br />�'. <br />n <br />o� <br />c <br />� ;. <br />H� <br />� ;: <br />�: <br />2 ` <br />�` <br />c : <br />� .. <br />� i: <br />