HomeMy WebLinkAbout2446 UNICORNIO ST; ; 77-3056; PermitMODEL NO.-.--~--\: ____ _
BUILDING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicanttocompletenumberedspacesonly Phone 729-1181 Perm it No -,
JO~z:.•4 '-I ta LJ ;\J \ L t tL fi _, 1 C' J
.,-;('"-. ASSESSOR 'S
(-A \......0 r A"'C .. 1--'-I t-PARCEL NUMBER
L~4-, I OL K C••o
~•-,:. r□scc ATHCM£0 SMUT/
BOOK PAGE I PAR, Lt OA L I /f\~A ,::t;,, 1 Ot$CR. .,c,, -', n..
OWN CR MAIL A.OORC.S!i ZIP PMONE 2 I( ~ I I I\ (5 I /II /. ,A·7ft L ___ ,---=t. u, ,l.. A -t1 tT/ '
, f t-I I I CONTRACTOR .. MAIL. ADORCSS ~ ,I PMONC STATE LIC, NO. -FC.[Tl' C.!..c.,...'llo_j-,;;I' t-: -:> --, 'S f'.:. (LOu 7 3 ' I I I? <.'Z-. !::) L) f i.. . . ,~ l f ).;.., ,c:; 2> ! . ..:. ' '-' ·-(.._ f -.-f
4RCMI TCCT OR O tSiGNCllt MAIL .t.OORESS , PMON C Lit <1?I NO. 4 , ,,, ~ • , . ~B, L,. _'. J( 1~
CNGINECR MAIL AOORESS PMONC LICC"ISC N O.
5 • /7 _, . .
,, COMPENSATION INS, CARRIER c..,,-...,.tu "t MAI L A00!'6S.S ~·I 1',r _,--' 8RANCM
6 t i'-'~ \ (. J,.. . t o. !ft ,~~:>~o.v V L . '~ J I \) c;_ ~ (.... -use Of' I UtLO/,..(;
,_A.,. ~. ' ~~ 7 I ~~ I t .. ; ' ,, r,.,-; <s,
NO. BDRMS NO. BATHS
:,_;, .
8 Class of work: ~~w 0 ADDITION 0 ALTERATION 0 REPAIR 0 MOVE 0 REMOVE ,1 /1
·2. ~~ -1:: Ill~ 'i 11 I 9 Describe work : I ' , L. -r· \._ t....,--,. D Orl /\ / -\., ~a I
,1
10 Change of use from '
/✓, '--0 Change of use to
~ ,,) ; J✓' 7 ,·o I I 11 Valuation of work: $ --PLAN CHECK FEES I/~ PERMIT FEE S / I
SPECIAL CONDITIONS: ; MICRO FlLM FEE Type of Occupancy -t ✓t Const. Group .
Sile of Bldg. i..2/ 7</ No. of Ma)(.
(Total) Sq. F Stories " 0cc. Load
/
Fire use Fire Sprinklers APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVE D FOR 1ss7E BY Zone _. Zone Required O Yes □No
OFFSTREET PARKING SPACES,
DAT!!:> f No. of
'
No. Dwell1n9 Units No. CATE Covered Sq, Ft. Open
NOTICE Speci al Approvals Required Received Not Required
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB-PLANNING DEPT.
ING. HEATING, VENTILATING O R AIR CONDITIONING. HEAL TH DEPT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF F IRE 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 (Speci fy!
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMIN ED THIS ENGINEERING DEPT. APPLICATION ANO KNOW THE SAM E TO BE TRUE ANO CO RRECT.
ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS WATER DEPT. TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, TH E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY O THER STATE OR LOCAL LAW REGULATING CONSTRUCTION O R THE PERFORMANCE OF CONSTRUCTION.
.i~ ... I ( I I 1 ,1 --~ • SIGNATVR[ 0,-CONTfltACTOllt Oflt AUTHOlltl ltO "'CENT (DATE)
51GNATU1':£ 0,-OWN [,. ,,. OWNClll 8UIL O[JIII) OATC)
WHEN PROPERLY VALIDATED UN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
·; I
TOTAL FEES $ _..::._"'--'~--...!-,1'...!J __
~ -
INSPECTOR
INSPECTION RECORD .
DATE REMARKS INSPECTOR
FOUNDATIONS:
SET BACK
TRENCH
REINFORCING
FOUNDATION WALL &
WEATHER PROOFING
CONCRETE SLAB
FRAMING
INT. LATHING OR DRYWALL
EXT. LATHING
MASONRY
FINAL
USE SPACE BELOW FOR NOTES, FOLLOW·UP, ETC.
6-3 77 Fdo . forms and steel. Q.K B Nelson
REQUEST FOR /h ,/
INSPECTION TIME /7 ~ •
Inspector __________ (2~------------------------------Pe,m;t No_---------------------------Date _ _,1~./2z.
Owner ____________________________ _
Address ..
BUILDING PLUMBING ELECTRICAL MISCELLANEOUS
Insulation ................. 0
Drywall .................... 0
Fdn. Forms .............. 0
Steel ........................ 0
Sheathing ................ 0
Lath .......................... D
Frame ...................... O
Final ....................... .
.................................. □ ................................ D Plenum & Ducts ....... 0
Gas .......................... O Pool Bonding .......... O Porch ........................ 0
Water Heater ............ O Temp Pole .............. 0 Patio ........................ 0
Sewer ············ .... o ................... D Driveway .................. D
Undergrnd. Plbg ....... O Underground .......... O Sign .......................... 0
Undergrnd. Wa ter .... Q Ceil Heat .............. O Wall .......................... O
Rough ...................... O Rough . .. . . .. .. ... .. . .. .. . O Fence ...................... 0
Final ........................ Final ...................... Grading .................... O
Thurs., Fri. r I,{_ (
···············; I , ;.······r:;;;)· .................... ..
............................................................ g~,c..,,z__ ...... /t/,,.'l;.Z.1..~ ...................... _.
Requested by .... :22... .. .. .... ... ...... .. ~
Phone number ........ ::75.'6 .. ::-... ~ ..... ;........... Person Taking Report: ...•.•. ~ ...................... .
Ready for Inspection --
Special Instructions --
Mon., Tues.,
ELECTRICAL PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only Phone 7 29-1181 Perm it No
f , )
I LOT N0.,,,.,,_9 LEGAL r-·
1 DESCR.
BLK,
4' • r□SEE ATTACHED SHEET)
OWNER MAIL ADDRESS
2 IA PHONE I STATE LIC, NO,
,, '
( 1 '/
MAIL ADDRESS "' \._V
l I\ 'I ' ,_ I ,,,_
:::. ,,., ~ r-r• I') ,_, r
j
CITY LIC, NO,
, l , l
ARCHITECT OR DESIGNER MAI L ADDIIESS PHONE LICENSE NO,
4 '") \ I --I f f'" (
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
COMPENSATION INS CARRI ER MAIL ADDRESS BRANCH
6 I ,.,.... ' -., " •_:: ;_. J \"" -C. r-'l.. • () ,..}
USE or BUILDING
7 J l
8 Class of work: ffe~EW 0 ADDITION 0 ALTERATION 0 REPAIR
9 Describe work: t.. lc,n .. \<..
PERMIT FEES
No.
SPECIAL CONDITIONS:
~--------------------------·-
""'LJCATION ACCEPTEO IV PLANS CHECKEO BY
NOTICE
-
APPROVED •~E 8 v
DAT~
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 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 AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCE~ GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED 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.
SWIMMING POOL WIRING,
NO INCREASE IN SERVICE
NEW CONSTRUCTION, FOR EACH
AMPERES OF MAIN SERVICE, SWITCH,
FUSE OR BREAKER
NEW SERVICE ON EXISTING BLDG.
FOR EA. AMPERE OF INCREASE
IN MAIN SERVICE, SWITCH, FUSE
OR BREAKER
REMODEL, ALTERATION, NO CHANGE
IN SERVICE, FOR EA. AMPERE OF
INCREASE
TEMP. SERVICE UP TO AND INCLUD-
ING 200 AMP.
/; 5 I ''1 I r/r.1 MP. SERVICE
/ / 1 PER 100
OVER 200 AMP.
/1 , ~l~t ..
SIGNATURE OF CONTR~CJOII OJ\ AUTHORIZED AGENT / (D,(TE) ISSUANCE FEE
TOTAL FEES
~lt;HATURE n OWNER Ir OWNER BUIIOER DATEl
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.
INSPECTOR
M.O.
Each Fee
.....
CASH
.
INSPECTION REPORTS
DATE ITEM REMARKS INSPECTOR
'
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC.
5-25-77 TE:!Tlp. O.K. B. Nelson
PLUMBING PERMIT APPLICATION -/ Permit No ____ City of CARLSBAD, CALIFORNIA ; / ';)
Ap_plicant to complete numbered spaces only. ...-~-) ,:_
,.....:.,J,;..,o•~ .. =0~0 .. ~£~S.-___:-~--L/---r-,-/+-(-r----,---+/-/_(_'!-/ __ {_r __ /_(_L ___ t' _________ -=..;:__.;;...__-r-""".l::r--"'7'1! i
I OLK I TIIACT D :n g :z LOT NO.
LEGAL I 1 DESCII, ( SEE ATTACHED SHEET} ;n?
OWNEllt ,.
2 ,rl ~ lr✓
CON TJ(AC TO" ---~ --3 -, ,, --/ ..
ARCHITt'tT 0,. DESIGNC.-: . d
4
ENGINEER
5
LEN DUI
6
USIE OF BUILDING
7
8 Class of work: qNEW 0 ADDITION
9 Describe work: J, , .-., ,..J ,,
SPECIAL CONDITIONS: ,._
APPLICATION ACCEPTl:D Bj PLANS CHECKED BV
MAIL ADDlltESS
MAIL ADDRESS
MAIL AOOIIIESS
MAIL ADDRESS
MAIL AOD,.ESS
0 ALTERATION
. t,. ·'
I
APPROVED FOR ISSUANCE av
PHONE
PHONE LICENSE NO.
/.
PHONC
PHONE LICENSE NO.
BlltANCH
0 REPAIR
PERMIT FEES
No. Type of Fixture or Item
..:::r WATER CLOSET (TOILET)
,2 BATHTUB
1(../ LAVATORY (WASH BASIN)
/ SHOWER
/ KITCHEN SINK & OISP.
/ DISHWASHER
LAUNDRY TRAY
Fee
i
u
/!1 "' "'
( ..:> J;. J ,.J.,_/<,--/+-_C_LO_T_H_E_s_w_A_S_H_E_R __________ +---l-'---1
J/.J I WATER HEATER ,
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
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 AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TD 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 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIC.NATURE Ot" CONTfltAC'TOIII OR :ilJTHOfllllZ£0 A~ENT
I
I
URINAL
DRINKING FOUNTAIN
FLOOR-SINK OR DRAIN
SLOP SINK
GASSYSTEMS:NO.OUTLETS
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTOR
VACUUM BREAKERS
LAWN SPRINKL ER SYSTEM
SEWER
CESSPOOL
SEPTIC TANK & PIT
PERMIT
~IC.N•TUIIIIC OP' 0WN£flt fl, OWNER l!IUILDER DATE) TOTAL FEE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.
INSPECTOR
I .., ·-
$ 7
CASH
INSPECTION REPORTS
DATE ITEM REMARKS INSPECTOR
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC.
5-25-77 Undergrourrl Plbg and water: O.K. B. Nelson
MECHANICAL PERMIT APPLICATION
Applicant to complete numbered spaces only
City of CARLSBAD, CALIFORNIA 92008
Phone 729-1181 Permit No 17-/X) ~
.JOl!I AOOft £S5
;:).. lt/l. • ( J IV I I"'"_ I' .Nr"). A. / / I') <-,
LOT NO, Im I T"ACT l0 SEE. ATTACHCD SHE.ET) 1 ~~=~~-
OWHtlll MAIL A.OOAtSS ZIP PHONE
2 LAflft./4 /vi_ I C,.Jf f-..,..,-I 77// ,tb-~e,A .C;,,Rl.5 8A./) 7 ,,,-)Op .~_·t-s-9? 3
CON T,tAC TOfl MAIL ADDIIICSS PHONC STAT~ LIC:. NO. CITY LIC. NO.
3-/kJ e-'1"'t" -fl,, ... -/,,,11,1~-r,,,,A~,nl/2 tf'I-' ti . i.l )i°"':/1,M/~AI-:!'J-4/ • 15~. :141 -µJ,.. ~.1-1..; ~ ~
APICHI TEC ~ 0111 OESfGNCft -MAIL AQO,tt.SS !>HON[ LICENSE NO.
4
[HGINE.CIII MAIL. AOOAt.55 PHONC LICCNSt NO,
5
L~NOUII MA.IL AODflll[.55 Bfl:ANCH
6 .
uat o, BUILDING
7
8 Class of work: ~EW 0 ADDITION 0 ALTERATION 0 REPAIR
9 Describe work:
,,
Type of Fuel: Oil D Nat. Gas ~ LPG. D . PERMIT FE S
SPECIAL CONDITIONS: No. Type of Equipment Fee
Air Cond. Units-H.P. Ea. $ ,, ' Refrigeration Units-H.P. Ea.
-.i-..c..-,-Boilers-H.P. Ea . .
Gas Fired A .C. Units-Tonnage Ea. JI
I Forced Air Systems-B.T.U. Jno M Ea. ~ .. OG
APPLICATION ACCEPTED 8Y PLANS CHE CKE 0 ev APPROVE 0 FOR ISSUANCE ev Gravity Systems-B.T.U. M Ea.
. _j_) --Floor Furnaces-B.T.U, M ieJ~.::.; / Wall Heaters.-B.T.U. M
NOTICE Unit He&ters-B.T.U. M
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-Evaporative Coolers
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 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
~r~L~i'tTJ?s7o1l~Oo~Nc'A~J'A~~:titorn:Jc1o;uG~°t~~~~-rctfg;rs Air Handling Unit-C.F.M.
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.
-~"] /JoL: ~ ~lb~-, ___ . ..__. --.. ..,--~ .. .-: . .--~--;~~":~-"""-..... --~-> ---SIGNA U"a'OI" \.OHTRACrlll 0111 AUTH0fll%CO AGCNT { (DATE)
' • ISSUANCE FEE s ~ oc:;
a111!w•TUfll. or OWNER Ur OWNE!lt IUILDE") {DA.Tl) TOTAL FEES s I 00
WHEN PROPERLY VALIDATED ON °fHIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. -M.O. CASH PERMIT VALIDATION CK. M.O . CASH
INSPECTOR
ll'JTEnpEP.'\RTf.~ENTt\L INFOR,MAJIO~_$HEET / 17
Bl)ILDING DEPARTMENT I DATE: 3--
BUILDING ADDRESS:.-----· oc/: # Jff_~CJ;~~.#. I _
======-=:-=====::===========================-=============-----=--=--=--=--=--=--
PL.A,I\Jr\'. ! NG DEPARTMENT
LOT SIZE _________ LOT WIDTH, ___________ ZONE. _____ _
UNrTS PFWVIDED ___ ALLOWED. ______ Yr-<KG. SPACES PROVI DED ______ f:EQ. __ , ___ _
', OF COVERAGE _____ A LLOWED _____ BLDG. HEIGHT _____ ALLOWEO
,·nONT SETUACl< ____ SIDE YARD _____ REA R YAnO ______ INTRUSIONS ______ _
1::t·NIF:ONMEI\ITAL PROTECTION REQ'TS. ___________ Lfa,NDSCAPE PLAN ______ _
/-\DDIT!OW.1.L COMMENTS _______ -~-----------------·-\ ___ _ . _a
ISSUE PERMIT ~-----DATE. 3.:;2_ •'VoccUPANCY ~
u.Jvrf..-eJr <1-11'1 u.J D ---NGI! 1i::ERll\!G DEPARTMENT
i.~~ ,~/C INDUSTRIAL WASTE,A,/c:,f-A~/•--/.:~ ..
,,. ~,OV!:MENTS ~a:;.rt?$ SEWER CONNECl IO~J L..-_· _cZ_t:<:>___;.c...J> ______ _
DRIVE1N.l,Y l.OCATIOl\lS O A;.L;~--t-C>lweiyt"e--h(rl--r~ GRADING PERMtT.lk.J!.G ; f <1cva..Y.
EASEMENTSP~ ~F./t_, S: '~se @ ~-co+ ~,'-t?e? DRAI NAGE~~~..v~-=-e_s __
LF.GAL DESCR IPTION Lat: f~16c:z t?os-h lf'/eqc:4:?d)s ~~ ~~ . 0f!jC:C:)
ADDITIONAL COMMENTS e:-t!JP ff <f0 (:v G;: ,4.J ,;'(+~.If=._; t;¢ .. tl@;,P..
T ->e~ ~J <-??:? r>~ >
1ssuE PERMIT £ij/L DATE:s/z/7 Z occuPANC~ oA-rli~z..-7 2
FIR!: DEPARTMENT
SPRiNKLING SYSTEM
..
ROT[CT!Of\! EQUIPMENT
'DR.AI\ITS
ADDiTIONAL COMMENTS __
.
ISSUE PERMIT ______ _
•
____ FIRE ALARMS
LOCATION _____________ _
DA TE _________ OCCUPANCY ______ DATE ____ _
-·--·=-=-=-=-=-=-=-==-=-=--==--===============--=--=-=-=-=-=-===--.::::=-=-=-=-=-================-=·--=--=-=--=-==---
Y\lATER _QEPARTMEl~T
____ QLIVENHAIN ____ SAN MARCOS ___ _
ISSUI:: PF .M! T ______________ D/\TE_ ________________ OCC1J f1.l\~JCY ____ _
R. L. DOANE
R. SPENCER
E.W.KELLY
Mr. Roger Forburger
P.O. Box 59
POST OFFICE BOX 1532
RAN CHO SANTA FE, CALIFORNIA 92067
756-1107
May 11, 1977
PLANNING
CIVI L ENGINEE RING
SURVE YING
Rancho Santa Fe, California 92067
S ubject: Moistur e content of soil on Lot 49,
M eadows Unit N o. 1 , Rancho L a
Costa (2446 l Jnicornio).
0/V. 0 . #77-41 38)
Dear Mr. Forburger:
In accordance with your request we have made a determination of the m oisture
content of the soils that m ake up the existing pad on the above lot owned by
Laura Michetti in Rancho La Costa.
Two borings were made in the buulding area of the proposed two-story r esidence;
one in the Southwest corner and one in the m iddle of this a r ea. Separate samples
of soil were taken from the cuttings in each of the borings at 1 , 2 and 3 foot depths .
The following figures are the moisture contents of each of the samples . They are
expressed as percentages when the weight of the water content is compar ed to the
weight of the dried soil samples.
DEPTH
1 ft.
2 ft.
3 ft.
S OUTHWEST C ORNER BORING
24. 4%
22.8%
22.0%
MIDDLE BORING
25. 7%
22.1%
20.9%
These moisture contents a re a minimum of 2 to 4% above optimum m oi s ture
content that is required by t he City of Carls bad's Building Department.
T he soil encountered is classified as a light brown sandy clay (CL) and i s
expansive.
If you have any questions, please contact us .
RLD :ved
Yours ver y trul y ,
RANCHO S A NTA FE ENGINEERING CO.
/?~~
R. L. Doane
R . C . E. 20050
LEUCADIA COUNTY WATER DISTRICT
APPLICATION FOR SEWER SERVICE
Owner's Name: Laura Michitti
Mailin~ Address: 3212 Azahar Pl
Carlsbad, Calif 92008
Service Address: 2446 Unicornio
TrRct Description: lot 49 Lacosta Meadows unit 1
Type of Building: single family No. Units 1 ---
Lateral Size: 4" 6" 8" Saddle:
Easement Connection
Phone No. 753-6955
Connection Charge$600.00
Extra footage: @ $ __ _ ---
Extra depth: ____ @ $ __ _
Amount Rec'd $ 600. 00
How Paid ck#1873 -='-'-"--=.:....=.------I Da t e Paid _.:5:::....--=2=----'-7 ___ ~
Rec'd b
Lateral Charge
Total $600.00
The application must be signed by the owner (or his authorized representative) of the
property to be served. The total charges must be paid to the District at the time the
application is submitted.
If a service lateral is required, it will be installed by the Leucadia County Water
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 applicanb. 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 lateral.
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 REPRESENTATIVE, 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 service charge, billed bi-monthly in advance. The rate will be governed by the
use of the property, single family, multiple dwelling or connnercial.. Non-payment of
the sewer service charge is subject to a 5% penalty per month, plus disconnection if
necessary.
The undersigned es that the above information given is correct and agrees to
con itions as stat
5-2-7 6696
Date Account No.