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- BUILDING PERMIT INFORMATION <br />ADDkESS ��� % - G� � /Qv�' � �. <br />TYPE OF BUILDING � ' � �� <br />1) BUILDING PERMIT L'EE 'I �S� =�7 <br />(A) PLAN CI-IECK FEE <br />DATE�I�c�J-7,� <br />� Iz4vc <br />$ LP G . vt� <br />,c;f� <br />�- -��., <br />2) �t'ATER SERVIGE TO BE PAID B�I'OR� IIUILDING 4-�' �, '' � <br />PERMLT IS ISSUED W < < � <br />�A) TO BE DETERMINED BY PLBG. INSP.�� INCII <br />(B) EXIST. �VATER S�RVICE, APPL, NO. <br />(C) LOCATION STuB6(%� l� S•E� �i��%� <br />G�D,PN�,e C I-IA R T�—a �( <br />3) DRIVEWAY PERMIT TO BE PAID BEI'OR� BUILDING <br />P�RYIIT IS ISS�JED `y�,� FT. ��'fj{�('C, D/�V (TYPE) <br />4) STATUS OF SE11'ER CHARGES: <br />F30ND �DISTRICT .3.� <br />Lil:\L1Jl.!-lYL' 1\V1r.J <br />_ C� � � �� C� <br />TOTAL�� <br />FOOTAGE <br />N, S, E, �1'. <br />s ���s� <br />S �Lt�-`�= <br />� � �� <br />SE�4'1:R CONNECTION CHARGES: <br />TRUN� ��_ C^ J. �(� � <br />LATERA�L ����/��/$�-- <br />TOTAL CONNECTION CHARGE 5 CQ ,i � � C7 � <br />SEWER PERMIT FEE <br />GATCH BASIN PERA4IT FEE <br />TOTAL SEZ�'ER PERMIT FEES <br />s 3� - c� c� <br />$ �_'_" <br />S�JGei.'� �1 % <br />5 j`.:O\ THLY S�\I'ER CfiARGES: <br />SE�YER CONSTRUCTIOI�': ,� � / <br />TRUIvIC $ a d� <br />LATERAL S � <br />S�\VrI2 SERVICE: S o�� S i� '' <br />Li::.::Tiv:'� G'r' SIDE �SER'ER OR T�E IN THE M�P.IN� CHART L- ��' -a �' _� <br />�� ��:.;'�.tir'� %� JO fi7'"l� �/L !-�i� <<�d>' �r 7 � �lMe:'T DF �j .41._ �%ICi� C�Ar%lL�O <br />,);)., , �, ,.. <br />?\FO C0�IPILE <br />R:� . _._':`,-. <br />�, �� :' i'.O A" 3 L : <br />�� I���I= t�tnl must be paid before building permit is issued. <br />DATE �G -a�-7,� <br />1�ATE �6 }3 %y <br />DATE �d ( � <br />