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HomeMy WebLinkAbout2438 UNICORNIO ST; ; 80-742; PermitLICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provi- sions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes- sions Code, and my license is In full force and el· feet. OWNER-BUILDER DECLARATION DI hereby affirm that I am exempt from the Con- tractor's License Law for the following reason (Sec. 7031.5 ,Business and Professions Code), Any city or county which requires a permit to con- struct, alter, improve, demolish, or repair any structure, prior to Its Issuance also requires the applicant for such permit to file a signed state- ment that he Is licensed pursuant to the provi• sions of the Contractor's License Law (Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code) or that is ex- empt therefrom and the basis for the alleged ex· emption. Any violation of Section 7031.5 by an ap- plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). □ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or of• fered for sale (Sec. 7044, Business and Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such Improvements are not Intended or of- fered for sale. If, however, the building or improve- ment Is sold within one year of completion, the owner-builder will have the burden of proving that he did not build. or Improve for the purpose of sale). '.JI, as owner of the property, am exclusively con- tracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not ap- ply to an owner of property ,.ho builds or Im• proves thereon, and who contracts for such pro- jects with a contractor(s) license pursuant to the contractor's License Law). I am exempt under Sec. _____ B. & P.C. for this reason ____________ _ Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of con• sent to self-insure, o, a certificate of Workers' Compensation lnsuranc , or a certified copy thereof (Se~. 3800, Labo,uvuco, ... _ I} POLICY N0--1.>......:~L=--a..---.cw.-,C.JL~ COMPANY ____ :,a__,A...:.....-'---- □Copy is filed with the ity. □Certified COP.Y Is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE fThls sllctlon need not be completed If the per- mit Is for one hundred dollars ($100) or less). I certify that lo the performance of the work for which this permit Is Issued, I shall not employ any person In any manner so as to become subject to the Workcn' Compensation Laws of California. NOTICE'tO APPLICANT: If, after making this Cer- tificate of Exemption, you should become subJect to the Workers' Compensation provisions of the Labor CC8e, you must forthwith comply with such provisions o! this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction ten• di_n_g _ag_ency for the perform_anc!_~f-t'!.~ ~~k (or / I. C IT Y O F CARLSBAD-BUILDING D EPARTME NT 1 USE BALL POINT PEN ONLY NO. I <)I 'i 3?. I I I I I I I EDR /ltlC71L IBoB DAv OWNER'S MAILING ,¢DRESS p. 0, Box 39'2.. f<~#k) APPLICATION & PERMIT 1200 ELM AVENUE (714) 438-5525 J APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES. JOB ADDRESS ;l~l 0 'flalf~oTION ~;;~Ni PERMIT NUMBER I I I I I ~,, ,,,.._e,NIO 1~11 ~II w,7f;2-, (t/3 ;,~N2R3 72E er; o:7~ffo ~ 1ir=;~s-,{ ~T3$L~SE ~A,.11)4 h_ '--~ CONTRACTO~'S ADDRESS CONTRACTOR'S 9Zo67 P.O. Bo, 3'1-Z e. rr,.r::.. ?!!;5-6,21.{ STATE LICENSE LOT BLOCK Jl1 ueo1v1s10N ¢/: / b~ ASSESSOR'S PARCEL NO. 3 DESIGNER 5"I c~. -a. 1 I ,5',-,215101-10 t o n £0w,~O Ht . f.6 ( ,stt>,-1 C. -5''-" oM:fg~tRci6,# J/ re .;-~,• I,. .• 1,·, DESC rRIP,TION OF WORK i:" • e .. •,~~,..,-Ill) o,;:.. ~ 3 Be 3BA 2 $1l)ll./' ~ o~/s-Ee/.~ A~s)..,M OS /cV£, DESIGNER'S PHONE ~J~D , f Sot..~ tk# CA.'lU>'X" t/8/-116~ ' GP LAND USE I RES. UNITS I P~RKING SPACE sf I NUMBER OF STORIES CENSUS TRACT ZONING Not V•Nd Unless M•chin• c.rtifi,d BLDG SO. n. BLOG USE occ. GP I STANDARD PLAN II I PLAN I °)o,_7 yo(_J TYPE CONST I occ. LOAD I QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT. _, fl EACH FIXTURE TRAP -,,.1.J-. .,,,. -1, INSTALL FURN. DUCTS UP TO 100,000 BTU '){. -- J EACH BUI LO ING SEWER .... __ OVER 100,000 BTU 1.,,-EACH WATER HEATER ANO/OR VENT i...,.. / BOILER/COMPRESSOR UP TO 3 HP v EACH GAS SYSTEM 1 TO 4 OUTLETS 11-..-BOILER/COMPRESSOR 3-15 HP VALUATION :J/f f!?~ EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP EACH INSTAL., ALTER, REPAIR WATER PIPE ..,__... VENT FAN SINGLE DUCT (./.. - EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS I WATER SOFTNER --Z,.-r RELOCATION OF EA FURNACE/HEATER BUILDING PERMII,---I .I.ft.JI t,. ll-0 Issue 3. Q1 I s sue 3 .. Ul SIGN PERM1}1"./'1 J' -lt-9<7 ............ I , I I I TOTAL PLUMBING .. h,.. ~ TOTAL MECHANICAL If--PLAN CHI# lf .:?.,J(J -11"/Y?/ 1 ~ I I/1"2.,.-nlf) CONTRACTOR CONTRACTOR ALL INC~IVE PERMJT.J:)ilc._ "'l-0~ -, i' J • I AMT. TOTAL PLU~G ./ Lf I"'1-0lt:J QTY. ELECTRICAL PERMIT AMT. QTY. MOBILE HOME PERMIT ELECTRICAL I f ~lo -I NEW CONST EA AMP/SWT/BKR '2--0'0fl-.. r.o. / AWNING MECHANICAL I /L,""."Aln 1 PH .25 3 PH PORCH MOBILE HOME I I I EXIST BLDG EA AMP/SWT/BKR SET-UP SOLAR I . I I ,~ 1 PH .25 3 PH RAMADA, CABANA I , I I I REMODEL/ALTER PER CIRCUIT FENCE OVER 6' I I I I TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO·F I LM I , I I I OVER 200 AMPS I I I : I TEMP OCCUPANCY (30 DAYS) STRONG MOTION I . I /J")-.-, I / Issue 2.00 I I I • ' I • TOTAL ELECTRICAL [r~ TOTAL FEES PAYABLE l , Ji _(i ~.7i/ CONTRACTOR I I ~ ~ 0 ~ ~ j:: hl 0. V) ~ I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO ·AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER czscH 01 FEESfYf-~~ HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5'-0" DEEP AND DEMOLITION OR CONSTRUCTION OF ~~ ~ ~ FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY. STRUCTURES OVER 3 STORIES IN HEIGHT v..,._ ~ A~ COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER ~-/ , SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM- LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND . J 1t:J/,,71t EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE ~ OF THE GRANTING OF THIS PERMIT. cT]·ss11~E· /'\ OWN-~ CONTRACTOR□ !APPROVED BY J/1//i'°f'E/v ~ .A ,y...._ r -. AGENT 0 BY PHONE 0 -~ II -p -""-l LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provi- sions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes- sions Code, and my license Is in full force and ef- fect. OWNER-BUILDER DECLARATION D I hereby affirm that I am exempt from the Con- tractor's License Law tor the following reason (Sec. 7031.5,Buslness and Professions Code), Any city or county which requires a permit to con- struct, alter, Improve, demolish, or repair any structure, prior to its Issuance also requires the applicant for such permit to Ille a signed state- ment that he is licensed pursuant to the provi- sions of the Contractor's License Law (Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code) or that Is ex- empt therefrom and the basis for the alleged ex- emption. Any violation of Section 7031.5 by an ap- plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). D I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or of- fered for sale (Sec. 7044, Business and Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or of- fered for sale. If, however, the building or improve- ment Is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or Improve for the purpose of sale). '.JI, as owner of the property, am exclusively con- tracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not ap- ply to an owner of property 1•ho bullc\s or im- proves thereon, and who contracts for jects with a contractor(s) license purs contractor's License Law). I am exempt under Sec. K IV\! ~ for this reason , Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of con- sent to self-Insure, o, a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Labor Code). POLICY NO ____________ _ COMPANY ___________ _ □Copy Is filed with the city. □Certified copy Is hereby furnished. CERTIFICATE OF EXEMPTION FROM "WORKERS' COMPENSATION INSURANCE (This section need not be completed if the per• mlt is for one hundred dollars ($100) or less). I certify that In the performance of the work for which this permit Is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. NOTICE TO APPLICANT: If, after making this Cer• tlflcate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction len- ding agency for the performance of the work for 1,11hlrh thle ,,...,..,..,..1, le leetoaA IC.Ar ~no? f"'lull r.n..ta\ CITY OF CARLSBAD-BUILDING D E PARTME NT USE BALL POINT PEN ONLY APPLICATION & PERMIT 1200 ELM AVENUE (714) 438-5525 APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES. 2 Y-ttf I~ I I ~OB IAO~RESIS I I I I I I I I I I I ivRr-1°/~~7;;TION BUS. LICENSE :Z.,,,y.35"' PERMIT NUMBER OWNER ,;,--,--,-/✓,,,-,,,,___,,__,_ OWNER'S PHONE 0 " -3... V ---- LOT I BLOCK 7Tsueo1vls10N I A§sEssoii•s PARCEL No, I DESIGNER' I sH,TE LICENSE I I J I I I I I I I I I DESCRIPTION Of" WORK / --??-?_,;--✓--~ :~..I d~~~ -d-~-~1~4/,A DESIGNER'S ADDRESS DESIGNER'S PHONE 7 CENSUS TRACT 7 GP L ANO USE t7 I ZONINt' UNITS 1 RES, l PARKING SP.lCE 1 NUMBER Of STORIES Not V•lid Unless M•chin, c.rtifi«I BLOG SO, fT. BLOG USE QTY. PLUMBING PERMIT EACH FIXTURE TRAP EACH BUILDING SEWER EACH WATER HEATER AND/OR VENT EACH GAS SYSTEM 1 TO 4 0 UTLETS EACH GAS SYSTEM 5 OR MORE EACH INSTAL., ALTER. REPAIR WATER PIPE EACH LAWN SPRINKLER SYSTEM W~TER SOFTNER 77~ ALf1 --,;:7 TOTAL PLUMBING CONTRACTOR QTY. ELECTRICAL PERMIT NEW CONST EA AMP/SWT/BKR 1 PH .25 3 PH EXIST BLDG EA AMP/SWT/BKR 1 PH .25 3 PH REMODEL/ALTER PER CIRCUIT TEMP PO LE 200 AMPS OVER 200 AMPS TEMP OCCUPANCY (30 DAYSI "Tl ..A ""_,/ L..ll. TOTAL ELECT RI CAL CONTRACTOR occ. GP l STANDARD PLAN It I PLAN IO # I TYPE CONST AMT. QTY. MECHANICAL PERMIT INSTALL FURN. DUCTS UP TO 100,000 BTU OVER 100,000 BTU BOILER/COMPRESSOR UP TO 3 HP BOILER/COMPRESSOR 3-15 HP BOILER/COMPRESSOR 16-30 HP VENT FAN SINGLE DUCT MECH EXHAUST -HOOD/DUCTS RELOCATION OF EA FURNACE/HEATER ~ z ¢3:!----,; __ ,_ t7 TOTAL MECHANICAL CONTRACTOR AMT. QTY. MOBILE HOME PERMIT AWNING PORCH SET-UP RAMADA, CABANA FENCE OVER 6' TOTAL MOBILE HOME ,:;:,<..~ l occ. LO,lO T AMT. ~ < 0 ,;1-:r-v ~: ~ > BUILDING PERMIT ~ SIGN PERMIT j,.fd"'°_ II PLANCHECK I I I I I I f :----ALL INCLUSIVE PERMIT : : : : u ~ I . I I . ~ a. I I . I I :;2 AMT. TOTAL PLUMBING ELECTRICAL MECHANICAL MOBILE HOME I I · I - I I . I :t:t SOLAR I ' I I • I /} I' :a:-~ 7///tJ-tt,~ t,,1 -.,, 17 MfcO-FILM I • I I . I I . I I . I l , I I . I I • I I ' I TOTAL FEES PAYABLE I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM- LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS DVE/U /.fo-".' s·-o·· DEEP AND DEMOLITION OR CONSTRUCTION OF STRUCTURES OVER 3 STORIES IN HEIGHT I . : : : : :¥.} / OF THE GRANTING OF THIS PERMIT. APPLICANT-S SIGNATURE' OWNERQ AGENT D CONTRACTOR□ f APPROVED BY BY PHONED I ..,1,,,A cl@t!__ 7r -r-'5ATE I 'ii"'.:~· I ---._ --"!,~ "-"'T<&.-~--~~ -~ •• -";. __ ._,1,__..-;-•;;,;/~-; . ·::.:.: -~, .--: -=~_;.; ;:."~E:\~:·~--~ ~ )-:{ /A.~.A,0.1;.,\A ;,':\ f:-I\,&/». A,~#:. Ji:,Ji:v0 .1,,~, #:..A/AA./J,, ,1;;._ /:J,:\ ,'.Z\l~./!':-.. ii';, A 1;:JJ.-.l::,A~/4.,'t,.\J.v~.,~A AA.Mn p ~ <~ << -:. .. _:. .:: <-~ ~ ([ r· r 1 f f t r , t t 1~ CITY OF , 1 -,~ 1 t')· 1 • r , t 1-~ .. t ti ,· 1 ~ .., .i \l .; ,, •', ~ I i ( •oh .,. ~ l CA ,-1 , cqAn _,I ,, Jr~ ~~f·-' A,J ·-ti.I'- 1 This Certificate issued pursuant to the requirements of Section 306 ~ ~, ' . ...,. ~f'. .-.,:., ~,-... j of the Uniform Building Code certifies that at the time of issuance <i this structure complies with applicable ordinances of the City t regulating building construction use. ~ ~ ~ ,,,~ Use Classification Sin_gle Family Dwelling . Bldg. Permit No. ~-0 -7 4 2_ Group ________ Type Construct,011 ____ _ ___ Fire Zone _________ Use Zontt ___ _ Occuoantlood____________________ __ _ ____ ··----------·-·• --~ (, ~--~ » }> ~ ~ ~ ~ ~~ » s ..... :;,· ;> ..... ,, . ~ ... ,. ·:> ~ .. ·' -o .. nerdBuildin1 __ Ed Anti~/ Bo~ Day ,1ddr•·· _ P . o. __ BO}' 392, R_~n~_9_~;:mta te , 9 20 87 "-; B "Id Add . 2438 Un1corn10 L I Carlsbad, CA. 92008 ;: -<:< u1 1n9 rcss___ -------~---oca 1fy ·-----------------~ ' ~ ___ /) ~ <• .-.. < < ,:< . ;z;; ~ ---------------8~. I~ ~C->' <:..: NOTE: Alteration~, changes, additions o, chon~e,. of occup 1fic01e. ~ ;J (PoJI in con>picuou• place) ~ .,.-; ~~ ~ .ti V\:"V•/'~''v~'A;i'V"Y-r;''".'/"'1',;r~,f't/'v'c.i'':r•:··y,yY/v; '·:;w"?·v,':?t"':.r"1~·~1WWWV'~v.tW'?Y/~-~ ENGINEERING FINAL INSPECTION REQUEST TO: __ -,µ..,......~-----,.-~---(Datel REOUE ADDA ESS: ~ 3 d ~ PLAN CHECK NO. ___________ _ C. T. NO. _______________ _ CHECK LOTS _____________ _ FINALED: YES___ NO __ REAS T FINALE RETURN TO ENGINEERING CURRENT DEVELOPMENT ;; 1200 ELM AVENUE CARLSBAD, CALIFORNIA 92008 Date: 9-9-81 Qtitp of Qtarlsbab 'lb: Ed Anctil PC# 80_742 Dated: 10-22-80 P. 0. Box 392 SFD -2438 Unicornio St. Rancho Santa Fe, CA. 92067 Subject: Building Permit Expiration Dear Sir: TELEPHONE: '\" ./ 714 438-5525 Our records in:licate that your buildinJ permit will expire by limitation of time on 10-30-81. The provisions of UEC Section 303(ci) state: (d) Expiration. Every permit issued by the building official un:ier the provisions of this code shal l expire by l imitation and becare null and void if the building or work authorized by such permit is rot ccm112nccd within 180 days fran the date of such permit , or if the building or \\Ork authorized by such permit is suspended or abandoned at any time after the \\Ork is c:x:mteneed for a period of 180 days. Before such \\Ork can be reca:rrnenced, a new permit shall be f irst obtained so to do, and the fee therefor shal l be one-half the am::>unt required for a new permit for such \\Ork, provided no c hanges have been made or wil l be made in the original plans and speci fications for s uch \\Ork; and provided further that such sus- pension or abandonrrent has oot exceeded one year. Any permi ttee hol ding an unexpired permit may apply for an extension of the time within which he may corrmence w:>rk 1..lrrler that permit when he is unabl e to corrmence ¼Ork within the time r equired by this secti.on for good and satisfactory reasons. The buil ding offici al may extend the time for accion by the permittee f or a period oot exceeding 180 days upon written request by the permittee showing that circumstances beyorrl the control of the permittee have prevented action fran being taken. No permit shall te extended rroie than once. In order to renew action on a permit after expiration, the permittee shall pay a new full permit fee. Please check below indi cating your intentions and return this letter to us. Project abandoned. New permit will be obtained prior to carrnencing work. Maximum 180 day time extension requested. NOI'E: Separate letter for an ext ensi on request and reason for such must accanpany this fonn. If you have any question, please contact the Carlsbad Building Departrrent at 438-5525. Very truly yours, AA • /YL . Martlll Orenyak Building Official l,,,..} If L<-.... '3-<..//i._ ;,(/,-c ./,., ,l, d 1J e> "'"" -1-,-., «Rd Luo •c:_ f::. C)/,/ /-/..~.I' j:>•,aJ~c:f , C.J;.. 5/..._.,u../el /,"= ,,~ .. ,,,.~✓Y r--v ,[_ r (,,..;-,.:; r t) I-t) (1 hJ .J, 'C '" j GEOCON ENGINEERS AND GEOLOGISTS INCORPORATED File No. D-2390-JOl October · 29, 1980 Mr. Bob Day Post Office Box 392 • CONSULT ANTS IN THE APPLIED EARTH SCIENCES Rancho Santa Fe, California 92067 Subject: 2438 Unicornio Street Residence Carlsbad, CA CONSULTATION Dear Mr. Day: In accordance with your request we have visited the subject site and observed foundation excavations for the proposed residence. Our observations have indicated the previously graded site has been capped with a layer of relatively low expansive clayey sand of varying thickness. The cap is, in turn, underlain by moderately to highly expansive sandy clays. The grading operations for the project were tested and observed by Benton Engineering. Their report of the grading operations recommends that foundations extend to a minimum depth of 18 inches below adjacent building pad elevation. In addition, they recorrnnend that minimal reinforcement con- sist of one No. 4 bar top and bottom, and that concrete slabs-on-grade be reinforced with at least 6x6-10/10 wire mesh. The slabs should also be underlain with at least two inches of sand. Based upon our observations of the site, we concur with the foundation recorrnnendations as presented by the previous soil engineer. We also recommend that prior to the placement of concrete , the pad be periodically moistened with garden hos es or other sprinkler systems . In our opinion, a ponding or total saturation of the footings and/or slab area is not necessary. ■ 6645 CONVOY COURT • SAN DIEGO, CALIFORN IA 92111 • PHONE (714) 292-5100 J File No. D-2390-JOl October 29, 1980 It i s imperative that the site be properly fine graded to provide efficient site drainage which will direct excess storm and irrigati on water away from the structure and off the property into controlled drainage facilities . Under no conditions should water be allowed to pond on the site. Please contact us if you have questions or if we may be of further service. Very truly yours , GEOCON, INCORPORATED J copies: (2) addressee GEOCON INCORPORATED • ,, 0~1,,)er 's Name LEUCADIA COUNTY WATER DISTRI CT APPLICATION FOR SnJER SERVI CE Ed Ancti 1 Pho ne No . 436-2372 ------ M:. H in9 Address 2766 Galicia Wa.,__ _______ _ Carlsbad, Calif 92008 • .5erv hce Address: ______ ..a;.tJ_.t1J..S:,crvi 1 ~ Rr::;E:?T OF BUILDlNG PERMIT. Tract Description: lot 51 LC. rn I Assessor's Parcel No . BU!LD!N-'; PERMIT MUST Sc APPLIED FOR BY Cf -9 -if" c."> --------------Type of Building __ s_. f_. ______ No . Units _I __ Connection Fee$ 600 .00 Lateral Size: 411 __ ~-~ Sy..dte ~Ej•emepl-Cf>oo~,-t~~1ETJID Extra Footage: -~---_: 7,....._......., l ~t fi "(lJp h:, ? ): ~~~$) i /\ / ,! 11rr . f "\. I I C. I u' LJ : ... , ; i7 ·rJ, ~ I, 111 1r:"" r------------,::---~~--t-i~. , _ L--· L..... L!!~'::lei; u:,;e Amount Rec'd $4 cr-n--:;,~..... d --=--:--:.r .. =.· ... ··, rJ·'"'. ..,,:;_r;"i" __ 7 Prorated Sewer Ck . Mo/Cash 13S··~-··1v -' -' L !-. .z. (200.00) 4 00,oi) Date 9 _~'"--~-r\ ll Service Fee Rec'd By&. 11/2 Jr \.)/J Total $ lnou, m) ----------'~,'ff'F-......a AUTHORIZEifstGNA TURE 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 i·nstalled 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} wilere 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 ap pli- cant'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 INSP ECTED 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 . .l\NY CONNECTION MADE TO THE SERVICE LATERAL OR COLLEC- TION L lNE WITHOUT PRIOR APPROVAL AND INSPECTION BY THE DISTRICT WILL BE CONSJD ERE'il INVALID AND WILL NOT BE ACKNOWLEDGED. The prorated sewer service fee is based upon the date the District estimates that service will begin and covers the balance of the fiscal year. There will be no additional fee or refund if service actually conmences on a different date. For succeeding fiscal years, the sewer service fee will be collected on the tax roll fr, the same manner as property taxes. The undersigned hereby agrees that the above information given is correct and agrees to the conditi~ns as stated. Owner's Signature 1 ()7 ~ 3 Acc.Junt No.