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2000, 02-16 Permit: 52 Fee Collection Form
DIVISION OF ENGINEERING & ROADS FEE COLLECTION FORM APPLICANT: .G • ifiggflaDATE:A- /6-a O PHONE: # ea Fee Total Approach Inspection IIM$20 inommE, . Permit ria $10mou6..;�i Design Deviation 30 4 Q026 Environmental Checklist $75 0'024 rig;" Flood Plain Inspection $20 000$ -�� Permit $10 _, 949 Performance Bond 208 ' ' $1,000 Culvert 100 Curb Curb Cut $250 ■ Flood $300 Bonds Only ($ Amt) �q i s Special Permit __ $10 - I Construction in Right $30 "'' a: 0029 Work in Right -of -Way $100 + Without Permit insp. fee - Zoning Permit $200 Q NSF Charge $10 West Terrace Road Fund ($ Amt) 0028 i ,.. Misc. Const in County RW ($ Amt) ZZE0031 Harvard Road Miti.ation ($ Amt) 4E0030 Striping Co. Roads ($ Amt) - ZZE0032 Total Pro'ect Amount Due PAID DATE: - - • NOTES: