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t._IARTMENT OF COMMUNITY DEVELOPMCNT SERVICES <br /> BUILDING PERMIT INFORMATION <br /> ADDRESS !/O ;17ri-i /'i. S. LA-) --TYPE r-"k., <br /> (1) BUILDING PERMIT FEE _t, 4, r3W -a' $ �2. L3 . <br /> (A) PLAN CHECK FEE <br /> !¢ coo <br /> (2) PLUMBING <br /> (3) MECHANICAL p0 <br /> (4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE �' — <br /> (A) TO BE DETERMINED BY BLDG INSPECTOR INCH <br /> (B) EXIST. WATER SERVICE, APPLICATION NO. -- <br /> (C) APPROX. LOCATION <br /> ¢; j.Z W L.- N c (nuc_ L1 T, CHART <br /> (5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- <br /> SUANCE <br /> r FEET DRIVEWAY(TYPE) $ <br /> $ <br /> (7) S; %I US OF SEWER CHARGES: <br /> BOND ,- DISTRICT ce FOOTAGE <br /> N, S, E, W <br /> NOTES <br /> Lo Loq- B U <br /> SEWER CONNECTION CHARGES <br /> YcAR <br /> �' l TRUNK $ CU C) <br /> LATERAL <br /> TOTAL CONNECTION CHARGES $ yLJ <br /> SEWER PERMIT FEE $ 3�• �� <br /> CATCH BASIN PERMIT FEE <br /> TOTAL SEWER PERMIT FEES �3c1�3$ — <br /> (7) MONTHLY SEWER CHARGES: <br /> SEWER CONSTRUCTION TRUCK $ <br /> LATERAL — <br /> SEWER SERVIr,E <br /> APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: ? <br /> pIApe LL) N c <br /> CHART LL '2- <br /> INFO <br /> LINFO COMPILED BY: DATE — <br /> DATE <br /> APPROVAL: <br />