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l l,, rut, i w..- <br />ADDRESS Z10 omm, E'L. S•� <br />TYPE OF BUILDING DATE <br />1) BUILDINM PERMIT FEE Z9Z02.76- <br />(A) PLAN CHECK FEE <br />2) WATER SERVICE TO BE Pf..ID BEFORE BUILDING <br />PERMIT IS ISSUED _ <br />(A) TO BE DETERIMINED BY PLBG. INSP. y INCH <br />(B) EXIST. WATEr'. SERVICE, APPL. NC. <br />(C) LCCATION 57-oge D _ M !' nn4 Ai <br />S_ � 0a1?v4f--e CHANT s-a(�A <br />31 DRIVEWAY PERMIT TO BE PAID BEFORE LUIL=i G <br />U PERMIT IS ISS ED `at FI. ('oNCjer.TQ P'1: !TYPE) <br />TCTAL <br />' 41 STATUS OF SEICER CIL,%"GES:• <br />BOND DISTRICT_ FOOTAGE <br />_":D`C.`. CTEE IS%A'FR CC\XECT:C:� CILARGES: <br />TRL'\l; <br />LATERAL <br />TCTAL CONNECTION CHARGE <br />SEWER PERMIT FEE <br />$ z t,. �s — <br />s �D-dy <br />, (IRIS-0 <br />5 z05►. ?. <br />g 3 U . C) C) <br />CATCH BASIN PER`„IT FEE S <br />TOTAL SEWER PERMIT FEES S. . { <br />5) MONTHLY SEWER CHARGES: + 9 <br />SEWER CONSTRUCTION: I <br />TRUNK $ <br />k LATERAL $ ! <br />f` t <br />SEWER SERVICE: $ <br />LOCATION OF SIDE SEWER OR TEE IN THE MAIN: CHART <br />i / _ Re - S,40 i C) <br />X 7- <br />INFO COMPILED BY: lyDATE <br />REVIEW: `� '7 ��-� DATE <br />FFIC DI1'iSION <br />APPROVAL: DATE <br />"This total must be paid before building permit is issued. 4-Z1,Z <br />I <br />