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DEPARTMEHT OF COMMUNITT DEVElO►MENT SENVICES <br />BUILDING PERMIT INFOR11�1AT10(d <br />'��� �.r� TYPE � ,� /� <br />�2 0 ,Z 9� � � - <br />ADDREiS ��" ����` �� - y� ' = <br />(1) BUILDINC PERMIT FEE Y�,0�0 � b—'�T •—" <br />_ �-��=`T— - <br />(A) PLAN CHECK FEE ,��� <br />(2) PLUfv1BING � 5- <br />(3) MECHANICAL ' <br />(4) WATER SERYICE TO BE PAIU PRIOR TO BIJILDING PERMIT ISSU�NCE � 4 yaG <br />(A) TO BE DETERMINEU BY BLDG INSPECTOR �/-�— �NCH �, j������e. <br />,�c <br />(B) EXIST. WATER SERVICE, APPLICATION NO, _—. ����% ��<<` <br />(C) APPROX. LOCATION � ,.�`� If <br />G+`� c�� <br />cHnRt <br />(5) DRIVEWAY PERM�T TO BE PAID PRIOR TO DI�IL�DRIVEWAY(TYPE) S 4�3� <br />SUANCE FEET _---- <br />S <br />(7) STATU'i OF SEWER CHAKGES: <br />[30ND ��ISTRICT _FOOTAGE -- <br />N, S, E, W <br />NOTES <br />SEWER CONNECTION CHARGES <br />YEAR TRUNK <br />LATERAL ,J/. 3�0 ' � <br />TOTAL CONNECTICN CHARGES <br />SEWER I'ERMIT FEE <br />,° <br />.-2, D <br />� <br />4 � 30 <br />S 33n <br />Q/ <br />' 3a <br />CnTCH BASIN PERMIT FEE ; C <br />TOTAL SEWER PERMIT FEES ay�0 `� S <br />(7) MONTHLY SEWER CHARGES: <br />SEVVER CONSTRUCTION <br />T12UCK S 3 i � �_ <br />LATERAL <br />SEWER SERVICE <br />APPRCX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />INFO COMPILED EY: <br />APPROVAL: <br />9L�4 <br />CNART S �3�'z��Y <br />DATE <br />DATE <br />H 1- <br />� � <br />H ♦ <br />�� <br />R� <br />� `. <br />af <br />�� <br />�� <br />�: <br />�' <br />:; <br />:� ' <br />� <br />� <br />�� <br />� <br />