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! �J . � <br /> glJlLD � NG PERf1� IT INFORA�IATION � <br /> � <br /> � <br /> ADDRE55 TYPE���tC.L� t3�.�i��/ k��j I <br /> (1) BUILDING PERMIT FE L�..� ��.-� �Zg� ' (� I <br /> (A) PLAN CHECK FEE � I <br /> (2) PLUMBING -�`j', �(� �' <br /> (3) MECHA�JICAL ,S-� iI <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUII.DING PERIv11T ISSUANCE _ (.P"J6Jt�J I <br /> (A) TG BE DETERMINED 8Y BLDG INSPECTOR 3 INCH <br /> (B) EXIST. �NATER SERVIC[, APPLICATION O. <br /> (C) APPROX. LOCATION <br /> _ ( � <br /> CHART �� <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO I3UILDING PERMIT IS- ��� /l I ,�Y <br /> SUANCF F[[T DRIVEWAY(TYPE) � U `;'" <br /> S -:'d <br /> � <br /> (7) STATUS OF SE`Nf R CHARGES: � <br /> / / / :� <br /> BOND � DISTRICT FOOTAGE I � <br /> N, S, E, W ; <br /> NOTES i ';� <br /> S'F�1� (,IZILlT���� ,..� <br /> , <br /> �20 l ri'-� �- <br /> �� � �/ -7 �/.�� ! <br /> ��2��Z ����c� <br /> ` SEWFR CONNECTIUN CHARGES <br /> YEAR �� TRUNK S ��� � <br /> LATERAL <br /> TOTAL CC;�:NECTION CHARGES S ���•�'� <br /> SEWER PERMIT FEE S �� <br /> CATCH BASIN PERMIT �cE <br /> TOTAL SEWER PERMIT FEES S _ — - -c� � <br /> (7) MOIJTHLY SEWER CHAR�ES: <br /> SEWER CONSTRUCTION TRUCK S <br /> LATERAL <br /> SEWER SERVICE _ <br /> APPROX. LOCATION OF SIUE SEWER OR TEE IN THE MAIN: <br /> _ CHART <br /> INFOCOMPILEDBY: _ DATE <br /> APPROVAL: _ DATE <br /> ner <br />