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DE/ARTMENT OF COMMUNITT DEVEIOIMENT SERVIfFS <br />BUIL[)ING PERMIT INFORMATION <br />J � <br />�DDRESS �/ %� /d;; 7� ,/ . . � TYPE .�/ ' <br />(1) BUILDING PERMIT FEE ��,o � � <br />n o s •z�/ 9� �/ <br />T- <br />(A) PLAN CHECK FfE / 'J��ct. <br />(2) PLUMBINC ,.,?p a' <br />(3) MECNANIC�IL �j`� ( }� <br />(4) WATER SERVICE TO Bf P�,ID PRIOR TO BUILDING PERMIT ISSU1INCE t;6 �' <br />(A) TO BE UETERIv11NED �Y DLDG INSPECTOR �_ INCH <br />(B) EXIST. _ WATER SERVICE, APPLICATION NO. <br />(C) APf'ROX.IOCATION <br />CHART <br />(S) DRIVEWAY PERMIT �O BF PAID PRIOR TO BUILDING PERMIT I$- �,� <br />SUANCE �.� FEET DRIVEWAY(TYPE) S � �� <br />S <br />(7) STqTUS OP SEWER CHARGES: <br />BOND � DISTRICT _ <br />NOTES <br />L%�-,�,� //7/- � : . <br />.,..,.. , �. <br />� � <br /><✓,�-�• / 7 `r ; <br />�,�.�," y�! - <br />__ ��� <br />>� <br />FOOTAGE __ <br />N, S, E, W <br />SEWER CONNECTION CHARGES <br />YEAR „A�S TRUNK S 3� <br />LATERAL <br />TOTAL CONNECTION CHARGES S_ 33d _ <br />SEWEft PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT fEES <br />(7) MUNTHLY SFWER CHARGES: <br />5[WER CONSTRUCTION <br />SEWER SERVICE <br />s "3 0 <br />�- <br />S `� d — <br />1RUCK S <br />I.ATER�L <br />APPROX LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />INfOCOMPILLD f3Y. <br />APPROVAL: <br />5�84 <br />CHART <br />DAT E <br />DATE <br />