HomeMy WebLinkAbout2800 WILSON ST; ; SE658135; PermitCITY OF CARlSBAD
BUILDING DEPARTMENT 8 3:., SEWER
PERMIT • APPLICATION
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO.
BLOCK TRACT (./41 I LS C) Iv I A
USE OF
BUILDINGS
CONTRACTOR
ADDRESS
CITY
QCuNe,/(._
TEL. NO.
CONTRACTOR"S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO 3 PUBLIC SEWER @ $3.00
SEPTIC TANK. SEEPAGE PIT OR
PITS @ $5.00
OVERFLOW S EEPAGE PIT, ORAINFIELO EXTN.,
CESSPOOL, ORYWELL, MANHOLE @ si;.oo
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ S1.50
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER @ $1.50
ALTER. REPAIR OR ABANDON HOUSE
SEW ER OR DISPOSAL SYSTEM @ s2.00
@ $
OWNER'S I PERMIT s 2
AUTHORIZATION TOTAL FEE 5
oO
00 oo
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
C ONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD•
ING TO THE PUBLIC SEWER.
SIGNED THIS -----DAY OF ----------
OWNER OR
OWNER'S AGENT -----------------
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE RE•AD THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND
STATE LAWS REGULATING PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
A NO/OR LICENSED AS REQUIRED BY THE CITY OF CARLS-
BAD AND STATE OF CALIFORNIA OR THA I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RE ENTIAL P P·
ERTY.
SIGNATURE OF PERMITTE'l!'--..~-D,,,flZ'6-4r:-c:zC.....,.~_._#A-6'""'-~_.Ai:;...<'(i:_.A
Issued
BUILDING
ADDRESS
NEAREST
CROSS ST.
OWNER
MAIL
ADDRESS
CITY
Lateral Charge
30' H., 10' V.
Add. Horiz.
Add. Vert.
11 -65* p~~D1Jlf7*****181.5Q
TEL. NO.
CONNECTION DATA
Computation j /S',00 @ 4" = ___ 6" ----
@ 4" = ___ 6" ----
@ 4" = 6,, ---- ----
10% Service Charge
Lat. No.: Logged in Plat:
LINE COST DATA r-7 • CIJ I t..S o V -.l , A. D. & Assmt. No. _______________ _
LINE COST:
C. C. @__L_ I dwelling _______ _ 50.00
P. S. @ __ / dwelling ________ -#----
OTHER
TOTA
Grand Total, lateral, e .r--=-'-~=-~
FOR SEWER LOCATION
~-----------------1~
St. NORTH
ENGINEERING SEWER DEPT.