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ENGINEERING DEPARTMENT <br />BUILDING PERMIT INFORMATION <br />ADDRESS Q 3- N S E. TYPE_C o <br />i <br />1) BUILDING PER14IT FEE $ <br />(A) PLAN CHECK FEE $-- <br />2) WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETERMINED BY PLBG. INSP. Z. INCH , <br />(B) EXIST. --- WATER SERVICE, APPL. NO. <br />(C) APPROX. LOCATION1GvD.l•n:a;caT /Q'J=yS%S.k! <br />•►` IC. P/r —opt— a.a s •f E •f <br />I�f� • n S, r1L CHART <br />3) DRIVEWAY PERI-1IT TO /BE PAID BE:'ORE BUILDING <br />Y <br />PERMIT IS ISSUED JQ_ FT. A110 /r D/W (TYPE) <br />TOTAL* $ <br />4) STATUS OF SEWER CHARGES: ---= <br />BOND_TEr DISTRICT_'{ 1�. FOOTAGE 7,2 <br />,e <br />N, S, ') W. <br />3--3to- Wiz- 01 <br />NOTES -' <br />( JipwFr %041 hive to be <br />CGnftr...e}mod f►*IA P.V. D. <br />R/vi W. a/ew' See. /:no <br />1Le /Oorw St 5.r. (ILVO, <br />1� ever wid th <br />5) MONTHLY SE)iGR CHARGES: <br />SEWER CONSTRUCTION: <br />i 4- - 17h7 <br />SEWER SL'RVICE: <br />SEWER CONNECTION CHARGES: <br />YEAR 17 (� TRUNK <br />TOTAL CONN1 CTI0v' *7Ayr <br />SEWER PERMIT FEE <br />/OAS'!/( eq <br />CATCH BASIN PERMIT FEE <br />I <br />TOTAL SEWER <br />PERMIT rEErS <br />fV d. <br />TRUNK /A <br />LATERAL Ihh� <br />APPRO�X. AL�OCATION OF SIDE. SEWER OR TEE IN THE MAIN: <br />I �lLu--llu 2 so �E of E �ni/ r /O0 r~ S % S'. <br />— _ CH <br />INFO COMPILED BY: <br />j REVIEW: ------- <br />-- <br />P1;OJECTS DIVISION ' <br />APPROVAL: <br />-- ENGINEERING DEPARTMENT <br />$_ / 00 , so <br />$ _/JD. oe <br />$ <br />$ <br />$_ me e <br />/1 wru2 HH BS; of <br />DATE? -=f <br />DATE <br />DATE <br />* This total must be paid before building permit is issued. <br />