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Home My WebLink About2511 UNICORNIO ST; ; 73-215; PermitBUILDING PERMIT APPLICATION Permit No. Zi-Ji~ Applicant to complete numbered spaces only. City of CARLSBAD, CALIFORNIA 92008 Phone 7 29-1181 • JOI AOOR ESS 0 '- 5+ :f. 0 _!l 5// I }11,11n1>n10 z ti) "' ► LOT NO. ILK I T::~ 6800 " 0 LEGAL I <OsEt ATTACHto sHttTI 0 1 0£5C~. 1Ul . }C' " ~ "' OWNUt MAIL AOOllltSS ZIP PHOM£ "' "' 2 La Coilta Lana :-·-au :1.Je1 Har LI.-"'--,._-La Coata. (..a. 92008 -714/72~9111 i CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. 3 r ... i'i~ .. --71•/72Q-Qu, Cl7CJ8'2l ; ,_.,.. 1:1,..41 ,1---JMi ft1 ,,._,,__ u~-1 _.,. __ ,. --1..-.1 A.llllCHITECT Ofll DESIGN£lll MAIL AOOfllESS PHONE L ICENSE NO, i 1- 4 1·~ l\,a,,.. cJ.aaD1-'t?1l\ A .. ~-,..ta 1• 'PI--;--~ -TA'l1.-. ca. 92017 -714/4S~26u6 (2413) Ir~ ENGINEER MAIL ADDRESS PHONE LICENSE NO, 5 "\ I• LtNOEII MAIL AOD,.ESS BRANCH 6 use OP' BUILDING • 7 ~ .... 1• 1'--1.1-~,, ..... - 8 Class of work: ~EW 0 ADDITION 0 ALTERATION 0 REPAIR 0 MOVE 0 REMOVE 9 Describe work: 8ood :i.-&D4Stucco 0-"AJ{)~r~ I " , -r-1-t !2., r-;evr r r f) "'j- 10 Change of use from Change of use to • 11 Valuation of work: $ l5.000 II ,-4 fl I PERMIT FEE , ... PLAN CHECK FEE JI l .. SPECIAL CONDITIONS: Type of Occupancy Const. Group Division . Size ol Bldg, No. ol Max. (T otal) Sq. Ft. Stories 0cc. Load Fire Use Fire Sprinklers APPLICATION ACCEPTED BV PLANS CHECl<ED BV APPROVED FOR ISSUANCE BV Zone r r..,.-Zone Required □Yes □No No. Of OFFSTREET PARKING SPACES: ~-I Dwelling Units Covered ) Uncovered NOTICE Special Approvals Required Received Not R equired SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB-ZONING ING, HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF FIRE DEPT. CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. OTHER (Specify) I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN O R NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.· t..~ ' ,, 51GN~T\JR:£ o, CONTfltACTOR: Oft AUTHOAIZED AGENT 1oA'PEI 51GNATUft:E 01" OWNEft ,,. OWNCflt IIUILDEft DATt) WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH INSPECTOR -0 "' 3 :z 0 INSPECTION RECORD DATE REMARKS INSPECTOR FOUNDATIONS: ~/ SET BACK V . TRENCH ' ✓ REINFORCING I FOUNDATION WALL & ~/Ir vu4 WEATHER PROOFING , ' CONCRETE SLAB FRAMING 7/12/73 O.K. B. Nelson INT. LATHING OR DRYWALL 8/2/73 O.K. B. Nelson EXT. LATHING 8-2-73 O.K. B. Nelson MASONRY FINAL //-/S ... /. ., ~,<" -:,/U"uL" USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC. 6/27/73 Sheat hing O.K. B. Nel son PLUMBING PERMIT APPLICATION Permit No. 12 I City of CARLSBAD, CALIFORNIA Applicant to complete numbered spaces only. JOB ADDA 11!:SS ~ .1-:· / C"u. Z-l n -Of' Jo St., -:. r I ~ ~d. LOT NO. I BLK I T"ACT Qstt ATTACHED SH[[TJ LEGAL I 1 DtSC~. 12r R6!''1..ho Lo Costa OWNER MAIL ADDfU:ss ZIP PHONC 2 -c, I IL 7682 c I ,:;am l ., , . I • C rlsbad, Ca. • CON TRAC TO" MAIL ADDRESS PHONI: 66•-<h7f LICENSE. NO. 3 l ' ,f"1.. UJG ~ HEATI J. 1Ja✓.' •• G~ Alvarado Rew.:!, ;...:i ·~. ,..,a.?20 1 AlltCHITECT OR OtSIGNtlll MAIL AODIIIESS PHONE LICEN9l NO, 4 ENGINEER MAIL ADDRESS PHONC LICE.NS£ NO, 5 LENOEIII MAIL ADOR:ESS BRANCH 6 US£ OF BUil.DiNG 7 -i..1o~ 8 Class of work: ~ NEW 0 ADDITION □ AL TE RATION 0 REPAIR - 9 Describe work: Pl (ng PERMIT FEES No. Type of Fixture or Item SPECIAL CONDITIONS: ~ WATER CLOSET (TOILET) !) BATHTUB I LAVATORY (WASH BASIN) I SHOWER 1 KITCHEN SINK & OISP. J DISHWASHER APPLICATION ACCE~D BY PLANS CHECKED BV APPROVED FOR ISSUANCE BV LAUNDRY TRAY , I CLOTHES WASHER //✓\ / .l __r'. J WATER HEATER NOTICE , URINAL THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-DRINKING FOUNTAIN TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF FLOOR-SINK OR DRAIN CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-I 4W,,Q.PSINK ,lj,.. .. MENCED. / GASSYSTEMS:NO.OUTLETS I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CORRECT. WATER PIPING & TREATING EQUIP. ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED WASTE INTERCEPTOR HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE VACUUM BREAKERS PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. LAWN SPRINKLER SYSTEM / SEWER Q CESSPOOL -n - ,_:>L--\,.., SEPTIC TANK & PIT l· p I• .., -... , SIG\IATU"E. OP' CONT,.AtTdft 0,. AUTHORIZE~ AGE.NT CDATEI I PERMIT SICiNATUII£ OP' OWN[ft 1 P' OWN£,-BU ILOtft DATE) TOTAL FEE WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M,O. INSPECTOR . ll 0 ~ z "" .,, l)- ~ --= I;;;! ,,, ---1 Y' 135367 i> n + ' ' ~ , I :') ~ Fee $ ~ I ,,, .... , -◄ I J I ., '-0 IJJ )> 0 0 -0 "' 3 :z 0 l). "' "' "' l ' ' ,. I ,, . ., ,, - $ $ •I CASH INSPECTION AEPORTS DATE ITEM REMARKS INSPECTOR I I A y/ l /77 ,;.;' ~' ~.~~·~ ,,,"A 4 11.~Jo fl I ( ' 6/27/7, Gas ) O.K. B. Nel son 6/27/ 7'3 rough Too out O.K. B. Nelson 7/11/73 $hewer Grade O.K. B. Nel son 7/12/73 Tub O.K. B. Nelson . 9-19-73 Shower O.K. B. Nel son USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC. MECHANICAL PERMIT APPLICATION 0 '-,. 0 City of CARLSBAD, CALIFORNIA 92008 z IJJ ITI )> Permit No. -, ~-, 1 lJ 0 Phone 729-1181 .. -r .=. 610tr . ,. .. ~ Applicant to complete numbered spaces only. --, ~ "' JOB ADDJII ESS ' t JI . ✓ l.l JI /...) . JI LI.CAL I LOT NO/ ) ~ I OLK I T~A~-, 1,/,\ <Ost£ ATTACMco SHEET) 1 DUCll, v/ /I "l/, ' OWNE." MAIL ioo"ESS -f t, ?IP -PHONE 2 19/ / l r -" ,r,/,-, l '-~'/{.L I . I J/J 'If\ 1 I ' . CONTllAC T01l -, .... ,,.., . MAIL Mt>o,u::~s PHOHC > ~CEN:tr;t 3 J/1 ,I I /i /(, -, _ll ~ ) ( J ,ftJ 4 AJIICHITE.CT OJII 0£$1GN/ I -MA.IL ADDAESS . PHON [ LICENSE NO, ~ ENG IN EE" MAIL AODIIIESS PHONE LICENSE NO, \ 5 - LEN DUI MAIL ADD"ES.S 9JIIANCH 6 USE 01' 9UILDING 7 , ' 8 Class of work: ~EW 0 ADDITION 0 ALTERATION 0 REPAIR 9 Describe work: l !l t1 --X . - Type of Fuel: Oil D Nat. Gas D LPG. 0 PERMIT FEES SPECIAL CONDITIONS: No. Type of Equipment Fee Air Cond. Units-H.P. Ea. $ Refrigeration Units-H .P. Ea. Boilers-H.P. Ea. Gas Fired A.C. Units-Tonnage Ea. I Forced Air Systems-B.T.U. I ·...JQI Ea. ,I., APPLICATION ACCEPTEO ev PLANS CHECKED ev APPROVED FOR ISSUANCE ev , Gravity Systems-B.T.U. . M Ea. i /t ,: Floor Furnaces-B.T.U. M / // ..,(~~ Wall Heater~-B.T.U. M NOTICE ~ ' Unit Heaters-B.T.U. M THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-Evaporative Coolers TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF Clothes Dryers CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM• Ventilation Fan MENCED. Range Hood I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. Air Handling Unit-C.F.M. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED Incinerator HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. .IIGNATUflE 0,-CONTfllACTOfll O" AUTHOIIIIZCD AGENT (DATE) PERMIT $ .a. - •tG ,._y~ "r o, OWNCfl I,. OWNEfll IUILOUI OAT[) TOTAL FEE $ v I I WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH INSPECTOR :z 0 INSPECTION REPORTS ~ATE/ ITEM REMARKS INSPECTOR A i//0/73 ff.I IJ ,,./: h/lf --e,,,, ,. I -I / I USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC. ELECTRICAL PERMIT APPLICATION 0 :Ii ... 0 .,, (1) ~J,. ~ Permit N0 ')3-!'J.O City of CARLSBAD, CALIFORNIA 92008 "'·?.;-" S a . -91:9 ~ ;~~ Applicant to complete numbered spaces only. Jo• ADD" r.ss -: <,-// /1,(11Co#'1\//¥' LOT NO, I BLK LI..AL I 1 ocac~. , ..,_, y OWNUI 2 CONTflACTOfll 3 '!,,0;1, C £tp,1 ~. ......... ,.,,_ ,,,. ... ~ Phone 729-1181 5r. I T~ACT 0sec ATTACHED SHltl.TJ MAIL ADDfU.SS ZIP PMONC MAIL ADO"E.SS PHONE LICt.NSIE NO. 7?,$Z, U ~A,,.,~~u,nk f,,..t, 7,2q_q/// MAIL AODl'IIESS· PHONE LICl:NSt NO. 0 ,. "' .. z 0 .. . ' ( • 4 l='7<'/9v (t" ~-~ /; /~ 7(" ,?.,: ,,, ~,_,l./'--..F",H /. ,.' 7 "?-?i7(' ,,.,~'S(~< -CNGINEE" ., MAIL ADD .. ESS r PHONE LICCNSI: NO, 5 LI.NDUI: MAIL A00fl£SS • BflANC:H 6 usr. o, IUILDING 7 8 Class of work: □NEW 0 ADDITION 0 ALTERATION 0 REPAIR 9 Describe work: PERMIT FEES No, Each SPECIAL CONDITIONS: ISSUANCE OF EACH PERMIT APf'LICATION ACCEPTED BY: PLANS CHECKED BY· APPROVED FOR ISSUANCE BY: NEW CONSTRUCTION, FOR EACH AMPERES OF MAIN SERVICE, SWITCH, FUSE OR BREAKER L~ .. \. rJ. l~✓ \_() NEW SERVICE ON EXISTING BLOG, ' NOTICE FOR EA. AMPERE OF INCREASE IN MAIN SERVICE, SWITCH, FUSE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-OR BREAKER TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-REMODEL, ALTERATION, NO CHANGE MENCED, IN SERVICE, FOR EA. AMPERE OF I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS INCREASE APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT TEMP. SERVICE UP TO AND INC LUO· I PRESUME TO GIVE AUTHORITY TO VIOLATE DR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING ING 200 AMP. ,. CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. J:/0: TEMP. SERVICE OVER 200 AMP. 1, / ~ ~/// PER 100 ~? ~ -::. '3 a1GNATUIIIC OP' C.ONTIIACTOIII o" AUTHOIIIIIIZCD AGENT (DAUi MINIMUM PERMIT FEE I 7 (" TU■• 0~ OWNl':R I~ OWNER aUILDI:") -. ., DA.Tr. WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION CK. M.O. INSPECTOR Fee - 4.i ::.-.U' ~ ~ M 1-- INSPECTION REPORTS o y E ITEM REMARKS INSPECTOR / -.. <-,/-i,1.J 4 tu A-~ ~-,,,.,..,, )u-£: /I I I USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC. t• ~ ELECTRICAL PERMIT APPLICATION Permit No. / ,, / Applicant to complete numbered spaces only. City of CARLSBAD, CALIFORNIA 92008 Phone 729-1181 . "O ~ (D "a ► _, 0-0 :,oz ~ 0 ... JOa ADD" 1.SS ~ '5" / / /,,A s~.-,,, r .,u~ 1 ~~=~~-I LOT NO,/ / /j I OLK I TIOACT Qsu ATTACHED SHUTI 1, l-c--~...._ __ ....,.-'_._ ...... .__ ___ __..__ ___ __,,M-,-A,-,.l-,'L...,.A-:CD'.":OIO'.":EC:-9_9 _________ -::-%'.'-::I P,----------,,.PH""'.0:-N-l------✓--f ~ , lu .//,( . OWNlt" 2 /,, ., /L // z I CONT,.ACTO" .. --MAIL ADO .. r.ss PHONI. LICI.NSE NO. 3 i'--;_ C ~/✓ 0 ~ -..... :r✓• I/!! AflCHITl:CT Oft'"DltSIGNC" MAIL ADD"lSS· LICENSE NO, 4 l:NGINEl.fll MAIL AOOflESS PHONl LICENSE NO, 5 LEND&" 6 -------------.,.,.,....,..,.,,.,..------------------------1!~ , ... MAIL AODflESS t 8"ANC:H ['\.. I\ USI. 0,. 8UILDING 7 8 Class of work: 'ef NEW 0 ADDITION 0 ALTERATION 0 REPAIR 9 l 1-----------P_E_;__R_M_IT_F....:;E....;,E,.;.S __ ..,..... _______ -'i\_ ._ _________________________ ..,. No. Each Fee SPECIAL CONDITIONS: ISSUANCE OF EACH PERMIT NEW CONSTRUCTION, FOR EACH APPLICATJON ACCE'fED BY: PLANS CHECKED BY: APPROVED FOR ISSUANCE BY: AMPERES OF MAIN SERVICE, SWITCH, FUSE OR BREAKER /'/ .___/ \ f .....A_ NEW SERVICE ON EXISTING BLDG. 1--..;......;;..;;;._...;.._...,..__ ______ ...,..__;..... ________ ---I FOR EA. AMPERE OF INCREASE NOTICE IN MAIN SERVICE, SWITCH, FUSE THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUC-OR BREAKER TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHO~ITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 7 •1GNATUM_,,,P'~ONTRACT01t 011 AUTHOflllZl:D AGENT (DATE) A ••T OP' OWNUl IIP' OWNER aUILDllfl REMODEL, ALTERATION, NO CHANGE IN SERVICE, FOR EA. AMPERE OF INCREASE TEMP. SERVICE UP TO AND INCLUD· ING 200 AMP. TEMP. SERVICE OVER 200 AMP. PER 100 MINIMUM PERMIT FEE /.,,..1-r"-" / WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION CK. INSPECTOR I -, ~ ,-... ;'IC) 1, .-/. zt., I ~ 31 I C., l '- M.O. CASH 1'3r-101 / INSPECTION REPORTS DATE ITEM REMARKS INSPECTOR 7-?F.-71 Pl"'\11N h C::oo ho 1 n w 'R l\lo l cl"'\n 7-11-71 'Rl"'\n a h 0 K 'R !\Tol son,__ USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC. 7-26 -73 Raise 220 V. outlet i n garage to +18". Extend ground out to fasten clamp on copper coupling. B. Nel son BENTON ENGINEERING, JNC. APPLI ED 8011.. MECHAt-llC9 -FOUNDAT IONS '57!7 CONVOY COUHT SAN OlEGO, CAl..lf"OANIA 92111 PHIL IP HEN KING BENTON ~RU IIO'INT • CIVIL CNGINXUI November 12, 1973 Norco Builder3 La Costa Plaza 7682 El Camino Real Corlsbad, Colifomia 92008 Subje ct: Gentlemen: • Prof e ct .Nos. 70-10-28D and 72-5-16DF Supplemental Recommendations For Buildings• Located Approximately 3 Feet From Toe of Cut Slopes Lo Costa Meadows Unit Nos. 1 one;! 3 Carlsbad; Cal ifornio RECEIVED NOV 1 3 1973 T ltL~PH0 Nlt (714) 1565-l 9!HI T~js is to present an acceptable alternate to reco~mendotlons for the ·providing of a 6 feet of positive drainage slope away from the perimeter f~otings on Lots 118 and 128 of La Costa Meadows Unit No. 1 and on Lots 432, 488 and 493 of La Costa Meadows Unit No. 3, in Carlsbad, California. • j It is understood that some of the perimeter footings on these lots ore as close as 3 feet from the toe of the adjacent cut slopes. It is recommended that as an alternative to providing the sloping drainage away from the building footings for 6 feet, that a paved concrete side- walk section combined with o paved drainage· swole at the toe of cut that together ore 3 feet wide and sloped to collect oil surface water and conduct this away from the perimeter areas be installed, so that free water is ·prevented from ponding adjacent to any buildings. If you shoii1d desire any additional information~ please contact us. Respectfully submitted, BENTON ENGINEERING, INC. Distr: • (4) Addressee PHB/ew LEUCADIA COUNTY WATER DISTRICT APPLICATION FOR SEWER SERVICE Owne r's Name: La Costa Land Company Mailing Address: ______ C,..._,.o=s'-"t=a'--'D""---'=e=l~M=a=r_...,R=o-=a-=d __________ _ Rancho La Costa, Calif. 92008 Job Address: SERVICE REQUEST ED: CONNECTION CHARGE Iot ¾I= J 28 I.,Go Meadows u Unicornio St. for Single family residence(type of building) If a multiple unit building, indicate no. of living units ___ _ SERVICE LATERAL If service latera l previously installed -No Fee If service lateral required: Check size lateral required: (4")_ (6")_ Other __ _ · Saddl e connection required: Yes_ No __ TOTAL CHARGES Surcharge Fee Receipt No ___ 2_4_6_9_ Phone No. ____ _ COST 100.00 S---- 100".00 200.00 $=== The application must be signed by the owner (or his authorized representative) of the property to be served . The total charges must be paid t o the District at the time the application is s ubmitted: If a service lateral is required, it will be installed by the Leucadia County Wate r District. The service lateral is that part of the sewer system that extends from the main collection line in the street (or easement) to the point in the street (at or near the applicant's property line) where the service lateral is connected to the applicant's building sewer. The applicant is responsible for the construction, at the applicant's expense, of the sewer pipeline (building sewer) from the applicant's plumbing to the point in the street (or easement) where a connection is made to the service late ral. The connection of the applicant's building sewer to the service lateral shall be made by the applicant at his expense . The connection must be made in conformity with the District's ·specifications, rules and regulations; and it must be inspected and approved by the District before the sewer system may be used by the applicant. The applicant , or his authorized rep- resentative, must notify the District at the time inspection is desired . Any connection made to the service lateral or collection line without prior approval and inspection by the District will be considered invalid and will not be acknowledged. After connection is complete, the property described above is subject to a monthly sewer serv- ice charge. The rate will be governed by the use of the property -residential, commercial, or multiple dwelling . Non-payment of the sewer service charge is subject to a 5% penalty per month, plus disconnection if necessary. The undersigned hereby agrees that the above information given is correct and agree s to the conditions as stated: ./ r1 ./ -' C ~ t.. c.::,·,'"'J Cr!J-,-,,,;;;, c..; ~ wner's Signature Pco/~ /q?z. Date