HomeMy WebLinkAbout1055 CARLSBAD VILLAGE DR; ; SE646233; PermitCITY OF CARLSBAD
BUILDING DEPARTMENT _
SEWER
PERMIT -
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO
BLOCK
USE OF .-
BUILDINGS ' *> „ / /
CONTRACTOR & s£_.
ADDRESS <'r"Z_/V £-,
^CITY /£W/,V f tfj£l /
(^CONTRACTOR S STATE
T LICENSE NO
1 **-$ ty*~ -7
__ -^M S^ t
TRACT
•C t ~ & *> *
X" ft' ft (~r&^n 3LSSC, t
•> TEL NO -5T,? C?- 7 7X/'
CARLSBAD/ BUSINESS
LICENSE NO
NO DESCRIPTION OF WORK FEE
y HOUSE SEWER CONNECTING TO "7 XI
/ PUBLIC SEWER @ S3 OO _"5 rifj
SEPTIC TANK SEEPAGE PIT OR
PITS @ SSOO
OVSRF-LOW SELHAGE PT DRAINFIELO EXTN
CESSPOOL ORVWELL MANHOLE @ S5 OO
HOUSE SEWER CO^
PRIVA I E DISPOSAL
NECT1NG TO
SYSTEM @ $1 SO
CONNECT ADDITIONAL BLDG OR
ALTER REPAIR OR ABANDON HOUSE
SEWFR OR DISPOSAL SYSTEM @ 32 OO
@ $
OWNER'S
AUTHORIZATION
^A HAVE AT THIS DATE A
^FCONTRACIOR TO CONNEC
, - i THE PUBLIC SEW
w'VNtP OR
-' JPPFjS
PF'JMIT $ 2 OO
TOTAL FEE ^ fj&
CONTRACT WITH THE HEREIN
1 THE ABOVE DESCRIBED BUILD
ER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
FPLIC, riOM AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND
STATE LAWS REGULATING PLUMBING AND SEWERS
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS
BAD AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL
OWNER Of THE ABOVE DESCRIBED RESIDENTIAL PROP-
ERTY x" s - -
SIGNATURE /' / ^ - //X -T -~~~
•
BUILDING Xyr-j s — T~~ ~ /r- , C-.C-
ADDRESS 'C' *~> -i C> £— Ss/ O f
NEAREST
CROSS ST
OWNER ji-T1 /^^.' C f 7 "7~XV~7 XX.X"'' Z£&
MAIL / — s-
ADDRESS A*^" (T~ /--X^//^7/^/^ f /T7 : f >*• fC
CITY ^^-/U r^)/(_ ^Q TEL NO
CONNECTION DATA
Lateral Charge Computation
30 H 10' V CD 4" — /," —
Add Verr 0 4" — t," —
I0°/n ^flrv rf, Chnrrjfl
Lat No . Logged in Plat
LINE COST DATA
A D & Assmt Nn
1 IMF C.C,^
C C. (<t) / ^w^llmr,
P S (ft / r(«/pflm0
OTHPR
TOTAI
FOR SEWER LOCATION
St NORTH
ENGINEERING SEWER DEPT
Sinnpr) I ^ifjn^
'
This is a'Sewer Permit When Properly Filled Out, Signed and Validated
i«n«rJ Ry
PERMIT VALIDATION