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LNGINEI;RING D�PARmr9�N.T <br />- BUILDING PERMiT ZNFOF;lATION <br />ADDRESS �'' '� <br />_ r - . . . <br />— TYPE <br />1) IIUILDING PERhiIT FEE -- __---- <br />(A) PLAN CHECK FEE $ <br />$ ------- _ <br />2) WATER SERVICE TO BE PAID FtEFORE BUILUING <br />PERMIT IS :SSUED ., i <br />/i�' �� / $ <br />(A) TO BE DETERMINED BY P.LBG. INSP. ��/5/�``i — <br />� INCH � � ��i �,�. <br />(B) EXIST. --- WATER SERVICE, AYPL. NO. - <br />(C) APPROX. LOCATION � � <br />�:. i <br />. .� ! . <br />3) DRIVEWAY PERMIT TO IIE PAID BEFORE BUILpING C�RT ._ - <br />P�ItMIT IS ISSUED FT. " <br />D/�� (TYPE) g <br />4) STATUS OF SEWER CHARGES: TOTAL* $ <br />BOi�ID� pISTRICT FOOTAGE -� <br />� N, S, E, ;V, <br />INOTES SEt+TER CONNECTICN CHARGES: ���� `, <br />IYEAR TRUNK � $ ;.;• <br />3'�`�"`� S7-OU <br />I/� L/A�T'E L/ <br />�ON TT"�H �b $L"'�c.__ <br />TOTAL C NEC i C A GE �$ <br />, _ � p i :i�i^ <br />SE�4ER P�RI•1IT FEE � $ y� ,-n <br />CATCH BASIN PERf�1IT FEE $ ..�- <br />�) =�O;J'i'iti;Y S�i;ER CHAI2GES; � TOTAL SEWER PERMIT FEES ` $ -_ ,:�< <br />:!� , <br />i'-------- -- <br />SELVER CONSTRUCTIO:I: <br />TRUNK $ <br />LATERAL S � ,, <br />SE[�:�R SERVICE: <br />$ %.,:�i..� <br />APPROX LOCATION OP SIDE SE[0ER OR TEE IPI TH13 MAZN: �� <br />r�i . � ,� <br />- r' ^ � {- .I' "-i F-i . ..;.,;' f� - ' ��i� "'�' r�- c <br />._ .. .� :- .c. ,r. �. , CiIART • -- rt� _ •, . S . � . — <br />I':FO COMPILED BY: �--iv <br />_ _ DATE � !::-� I7 f <br />?2�;VI�[4: - <br />PROJECTS DIVISION D�1TE __ <br />'.PPROVAL: <br />ENGINEERING DEPARTMENT �PTE <br />* `i'h�s tor.�7. must be nai� }��fc <br />- r�- Lu.i?cing pc�rmit is issued. <br />