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ENGINEERING DEPARTMENT <br />BUILDING PERMIT INFORMATION <br />ADDRESS /'L Gf %�y JT <br />1) Ct1ILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />2) WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED <br />(A) TO BE DETERMINED BY PLBG. INSP. <br />INCH <br />(B) EXIST. WATER SERVICE, APPL. NO. <br />TYPE <br />S COD• 0 0 <br />Alw4 <br />^'ve o0 <br />(C) APPROX. LOCATIONps- <br />s� <br />3) DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING CHART <br />PERMIT IS ISSUED FT. COuc D/W (TYPE) <br />4) S7ATUS OF SEWER CHARGES: TOTAL* <br />BO:4D i; DISTRICT FOOTAGE <br />N, S, E, W. <br />SEWER CONSTRUCTION: <br />SEWER SERVICE: <br />APPROX. LOCATION OF SIDE <br />E 7 i iIE�)T A f--Z .-. <br />INFO COMPILED BY: <br />SEWER CONNECTION CHARGES: <br />YEAR 7 TRUNK $ /2 �� • �!tl <br />TOTAL CONN f NNHARGE $ ,196 <br />SEWER PERMIT FEE $ " <br />CATCH BASIN PERMIT FEE $ -- <br />TOTAL SEWER PERMIT FEES $� <br />TRUNK $ <br />LATERAL $ G . 7 S- <br />OR TEE IN THE MAIN: <br />JL - '�7 i iP. _ <br />REVIEii: <br />PROJECTS DIVISION <br />APPROVAL: <br />ENGINEERING DEPARTMENT <br />DATE <br />DATE <br />DATE <br />