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DEPM ..,141 OF COMMUNITY DEVEIOPMENI RVICES <br />E'WLPING PERMIT INFORMATION <br />ADDRESS --- TYPE _ 5q�E <br />(1) BUILDING PERMIT FEE 7(O/ GOO. 3EOl ' & D-- <br />(A) PLAN CHECK FEE ('za <br />(2) PLUMBING 20 •pQ <br />(3) MECHANICAL Z ' �90 — <br />(4) WATER SERVICE TO BE PAID PRIOR FO BUILDING PERMIT ISSUANCE OL.66 <br />(A) TO BE DETERMINED BY BLDG INSPECTOR —2. INCH <br />(B) EXIST. WATER SERVICE, APPLICATION NO. <br />(C) APPROX. LOCATION <br />Love- 01- L&-T CHART E-) Z <br />Cl <br />(5) DRIVEWAY PERMIT TO BE PAID PRIOR TO BUILDING PERMIT IS- <br />m <br />A-ZIfl'19y <br />SUANCE -- FEET --DRIVEWAY (TYPE) <br />$ <br />(7) STATUS OF SEWER CHARGES: <br />m <br />BOND _ FOOTAGE <br />rno <br />__DISIRICT <br />N, S, E, W <br />c <br />�1O1ES <br />- <br />rx <br />5 •F' �. �l(9O mc� <br />F <br />-� rn <br />x <br />0 <br />or <br />n rn <br />c v, <br />SEWER CONNECTION CHARGES <br />=c� <br />YEAR __TRUNK <br />-i r- <br />LATERAL <br />- <br />x, <br />TOTAL CONNECTION CHARGES <br />S <br />?dY•OD <br />_ <br />x <br />SEWER PERMIT FEE <br />s <br />tn <br />x <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />$ <br />��— <br />(7) MONTHLY SEWLR CHARGES: <br />SEWER CONSTRUCTION TRUCK <br />$ <br />— <br />LATERAL <br />SEV, ER SERVICE <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />INFO COMPILED BY: <br />APPROVAL: <br />91 /9 <br />C11AKT _ Z I -- <br />DATE <br />DATE <br />