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FOR �1FFICE USE ONLY <br />ADDRESS _ <br />(1) BUILDING PERMIT FFE <br />(A) PLAN CHECK FEE <br />(2) PLUMBING <br />(3) MECHANICAL <br />(4) STATE SURCHARGES <br />(A) DUILDING CODE <br />(B) ENERGY CODE <br />{5) DRIVEWAY PERMIT <br />(6) WATER SEfiVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br />(A) TO BE DETERMINED BY BLDG. INSPFCTOR INCH <br />(B) EXIST. WATER SERVICE. APPLICATION N0. <br />(7) STATUS OF SEWER CHARGFS: <br />BOND DISTRICT FOOTAGE <br />N, S, E, W <br />SYSTEMS DEVELOPMENT <br />WATER <br />:yaa���e� <br />TO7AL ORD. FEE <br />SEWER CONNECTION CHARGES <br />YEAR TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGES <br />SEWER PERMIT FEE <br />��i/Z C� �� ��� G"L'%/'� <br />��zz C' �� �3 y� _ �'i <br />$ <br />��'2 <br />��y <br />�29�� <br />$ <br />$ <br />