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nE�A�TMENT Oi�OMMUNITY OEVELO/MENT SERVItff <br /> � BUILDING PERMIT INFORMATION <br /> AUDRESS �L�`J� /00 Z� ''�� TYPE . GONlN1. <br /> (t) BUILnING PERMIT FEE ��0��� � s "253- 00 <br /> (A) PLAN CHECK FEE �p , <br /> (2) PLUMBINC <br /> (3) MECHANICAL -- <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDINC PERMIT ISCUANCE �� '�'�' ��l�'- <br /> (A) TO BE DETfRMINED BY BLDG INSPECTOR _ INCH <br /> (B) EXIST. WATER SERVICE, APPLICATIC)M NO. __ <br /> (C) APPROX LOC�TION <br /> —_ CHART <br /> (5) DR�VEWAY P[RMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- <br /> SUANCE __FEET DRlVEWAY(TYPE) S �75� '� 8 <br /> S <br /> (7) STATUS OF SEWER CHARCES <br /> BOND �. DISTRICT _ FOOTACE 45� <br /> N, � E, W <br /> NOTES <br /> �.� L�t� . � <br /> �� 4� -83 <br /> lz, q�o� x , o � qz <br /> � 1t9 . 23 <br /> SEWER CONNECTION CHARGES <br /> YEAR 8 � _TRUNK f � ��� ' �O <br /> UTERAL �o'� � Z 31 l . S� <br /> TOTAL CONNECTION CHARGES S d '-' �� • ST� <br /> SEWER PERMIT FEE S �O- D O <br /> CATCH BASIN PERMIT FEE �� <br /> TOTAL SEW[R PERMIT FEES �5� � � f _ a0•OO <br /> (7) MONTHLY SEWER CHARGES: <br /> SEWER CONSTRUCTICN TRUCK f _ <br /> LATERAL <br /> SEWER SERVICE _ <br /> �PPROX LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br /> CHART _ <br /> INFO COMPILED BY: DATE <br /> APPROVAL: DATE _ _ <br /> 5 B4 <br />