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� � <br />DEIA�TMENT Of COMMUNITY DEV[LO/MENT SE�VICES <br />BUILDIN�G PE�f�IT �w�ORMATION <br />ADDRESS �-�� � �;7j r� '.1.: c� �O-� T'YPC _ i7 J /�. /� <br />(1) BUILDING PERMIT FEE 3,4� O�d � S -��� � <br />(A) PL4N CHECK FEE �-ir�u= <br />(1) PLUMBING �.�0 � <br />(3) MECHANIC�L _? � <br />(4} V�'ATER SERVICE TO UE PAIU PRIGR TO BUiLDWG PERMIT i$SUANCE ��____ <br />(A) TO BE DETERMINED HY BLL�G INSPECTOR �� INCIi <br />(B) EXIST. WATER SFRVICE, APPLICATION NO. <br />(C) APPRU�. LUCATION _ <br />_ CHf�RT _ _ <br />(5) DRIVEWAY PERMIT TO EiE PAID F'RIOR TO BUILDING PERMIT IS- cl <br />SUANCE FEET DRIVEWAY(TYPE) S �� <br />E <br />(7) STATUS OF SEWER CHARGES: <br />E30ND . �1..�- DISTRICT <br />NOTES <br />�C��,,.: -�.� � //1/- �' s— <br />S � � �t <br />6e.��« /7n ',,. <br />�,,,,.- �7/ � <br />6 s° <br />FOQTAGE <br />N, 5, E, W <br />SEWER CONNECTION CHARGES <br />yEAR TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGES <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SfWER PERMIT FEES <br />(7) MONTNLY SEWER CHARGES: <br />. EWER CONSTRUCTION <br />S �'JD o� <br />f 33� <br />S 3� � <br />TRUCK S <br />LATERAL <br />SEWER SERVICE <br />APPRC»(. LOCATION OF SIDE SEINER OR TFE IN ThIE MAIN: <br />INFO COMPILED f3Y: <br />APPROVAL: <br />s en <br />CHART s /3 -��'' y <br />OATF. <br />DAl E <br />