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DEPARTM[NT Of �OMMUNITY DEVELOPMENT SERViCES <br />BIJILDI��� � t�"Et�MI� IiV�nRMAT10�1 <br />ADDRESS �D�o'Z `� �T.tf �D,2, lJ'. �� TYPE S "`�c.�,� ���.Y �c�s <br />(1) BUILDING PERM�T FEE ��2, aCX9.�o g�_OC] <br />(A) PLAN CHECK FEE 'S ( •�� nuc <br />(2) PLUMBINC �Z�-� DD __ <br />(3) MECHANICAL 3cI-��C.� _ <br />(4) WATER SERVICE TO BE PAID PRIOR TO BUILL`!t�G PERh11 ISSUANCE ��' BG� <br />(A) TO BE DETERMINED BY BLDG INSPECTOR _ "�� INCH <br />(B) EXIST. WATER SERVICE, APPLICATION NO. _ <br />(C) APPROX. LOCATION <br />CHART G -��'28�5 <br />(5) DRIVEWAY PERMIT TO BE PAID PRIG`R f0 BUILL)ING PERMIT IS- <br />SUANCE FEET Dr^.IVEWAY(TYPE) S 2��d0 <br />5 - <br />(7) STATUS OF SEWER CHARGES: <br />BOND -�� DISTRICT FOOTAGE <br />NO'fE5 <br />Sf�lra�. S�-u.lt�, �-�� <br />[92rJ <br />s .c= e <br />��, o <br />ll?I- �5�' <br />�90c�� <br />�Z9 •Oo <br />N, S, E, W <br />S�2 4?l•vo <br />��so.�c� <br />SEWER CONNECTION CHARGES <br />YEAR g � 7RUNK <br />LAT[RAL <br />TOTAL CONNECTION CHARCES <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />(7) MONTHLY SEWER CHARG[5: <br />SEWER CONSTRUCTION <br />SEWER SERVICE <br />g .�✓ 30. 4 D <br />`�7�"B'Ci <br />S <br />$ 3�� o0 <br />$ 3�.OD <br />TRUCK � <br />LATERAL <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />INFO COMPILED BY: <br />APPROVAL: <br />5�84 <br />_ CHART <br />DATE <br />DATE <br />