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ENGINEERING DEPARTMENT <br />BUILDING PERMIT INFORMATION <br />1' i �: s�� ' - - � -, <br />ADDRESS /, _.- ...> ' , :a.i'.". <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />� -j C����: � � <br />ti �� <br />2) WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERh;IT IS ISSUED <br />(A) TO BE DETERMINED BY PLBG. INSP. J�'%,� INCH <br />(B) EXIST. - -- - WATER :iERVICE, APPL. N0. -- <br />r.,_ <br />TYPE -- . j�, . <br />$ i�,f/ � � <br />� <br />$ '7 c-/ z� <br />$ _' !��,.. . L <br />(C) APPROX. LOCATION _ ":. /. �-" '" � :� . v >. ��. .. . . <br />�.''Z �f-�' �% .=�� �`c . . �. . ���/ O[�'. -'c?G/ CHART = -- �7 -- <br />3) DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED '.'_=� FT. ,:^-; �.;:"". D/W (TYPE) $ ; � <br />TOTAL* $ <br />9) STATUS OF SEWER CHARGES: — <br />BOND % DISTRICT �'` �- FOOTF.GE - <br />- Ni Sr E, W. <br />i <br />._ ' 1- � f � , -% " L'� CJ <br />a <br />SEWER CDNSTRUCTION: <br />SEWER SERVZCE: <br />APPROX. LOCATION OF SIllE SEWER <br />INFO COh1PILED BY: <br />f <br />SEWER CONNECTION CHARGES: <br />YEAR '��% TRUNK <br />n������ <br />iG�� /Z 7 , <br />TOTbL CONNECTI C AR E <br />SEWE;R PERMIT FEE <br />CATCH BASIN P�RMIT FEE <br />S ,� . . , /, r .' <br />$_ ____ <br />S /95.,,�0 <br />$ .�L�.r��.:� <br />$ �----. <br />�,- <br />TOTAL SEWER PERMIT FEES $ .�0.�/� �' <br />TRUNK $ �• l� <br />LATERAL $ — <br />$ � • ✓i_.% <br />TEE IN THE MAIP7: '=' /'i � � %��;; !. <br />>�``s� . h :� �u•.. — _ <br />REVIEW: /''� �{/Gt F'LJY�.� <br />PF:OJECTS DIVISION <br />, ,��APPROVAL: / <br />ENGINEEi2ING DEPARTMENT <br />- - .v __ �.n -� <br />DATE ,���7 -'�G, <br />/ <br />DATE ,5/ , � <br />i — <br />DATE � ,�j /-F <br />* This total must be paid before building permit is issued. <br />