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n <br />DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES <br />BUILDING PERMIT INFORMATION <br />TYPE F-e <br />ADDRESS 3 3Sg.OD <br />(1) BUILDING PERMIT FEE %S,OOt� c�.iS Ott( <br />(A) PLAN CHECK FEE z pa <br />(2) PLUMBING <br />(3) MECHANICAL <br />(4) WATER SERVICE TO BE PAID PRIOR TO BUILDING PERMIT ISSUANCE <br />(A) TO BE DETERMINED BY BLDG INSPECTOR ----!;, 4 INCH <br />(B) EXIST. WATER SERVICE, APPLICATIGN NO _ <br />(C) APPROX. LOCATION <br />CHART <br />(5) DRIVEWAY PERMIT TO BE r AID PRIOR TO BUILDING PERMIT <br />E M YPFI 3 ____ 2© '-� � - <br />IS- <br />SUANCE ._---FEET _---- <br />(7) STATUS OF SEWER CHARGES. FOOTAGE <br />BOND DISTRICT <br />N, S, E, W <br />NOTES <br />SEWER CONNECTION CHARGES <br />YCAR ____CC3f�TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGES <br />SEWER PERMIT FEE <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEES <br />(7) MONTHLY SEWER CHARGES: TRUCK <br />SEWER CONSTRUCTION <br />LATERAL <br />SEWER SERVICE <br />APPROX. LOCATION OF SIDE SEWER OR TEE IN THE MAIN: <br />$ 3sn•act <br />$ 3eo•t9rj <br />1 �� <br />2 <br />CHART <br />DATE <br />INFO COMPILED BY: DATE <br />APPROVAL: <br />H H <br />N x <br />v <br />m <br />cv <br />m0 <br />o <br />S <br />m <br />cz <br />5 84 <br />