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�� � <br />BUILDING PERMIT IN�ORI�IATION <br />nDDRESS �U��v ��� /��_ TYPE ��C�, <br />(1) BUILDING PEftMIT FEE $ _ � �J I �' <br />(A) PLAN CHFCK FEE -' <br />(2) PLUM8ING � <br />(3) MECHANICAL Q J�— <br />��J � <br />(4J WATER SERVICE TO NE PAID PRIOR TO BUILDING PERMIT ISSUANCE %�— <br />(A) TO BE DETERMIN[D QY BLDG INSPECTOR �.L�' INCH I�j�0 <br />((i) EXIST. _ WATER SeRVICE, APPLiCATION NO. <br />(C) APPROX. LOCr1TION _ <br />CHART <br />(5) DRIVEWAI' PERMIT TO B[ PAID PRIOR TO BUILDING PERMIT IS- nap <br />SUANCE FEET DRIVEWAY(TYPE) S ,-�%l ! <br />�_ <br />(7) STATUS OF SEW[R CHARGES: <br />BOND �_� DISTRICT <br />NOTES <br />ll"ll-�5J <br />FOOTAGE <br />N. 5, E. W <br />� � �� � �l�-l�� <br />L�� � ��.u9erl� <br />G� — <br />0 <br />SEWER CONNECTION CHARGES �2� <br />YEAR TRUNK S 6J�",V� <br />LATERAL <br />TOTAL CONNECTION CHARGES S _ �.��`— <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERlv11T FEES <br />, (7) MONTHLY SEWER CHAftGES: <br />' SEWER CONSTRUCTION <br />� <br />S L� � <br />S d,� �— <br />TRUCK 5 <br />LATERAL <br />SEWER SERVICE <br />APPKOX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />INFO COMPILED 8Y: <br />APPROVAL: _ <br />]/Fl] <br />CHART <br />DATE <br />DATE <br />