HomeMy WebLinkAbout1061 BUENA VISTA WAY; ; SE1966; PermitBUILDING DEPARTMENT PERMIT APPLICATION
PAID JUI 30-66 8~ZW3***+**SO.OO
FOR APPLICANT TO FILL IN I
LEGAL DESCRIPTION LOT NO.
BLOCK TRACT
USE OF BUILDINGS
CONTRACTOR
ADDRESS
CITY TEL. NO.
CONTRACTOR'S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
NO. I DESCRIPTION OF WORK FEE! I I I HOUSE SEWER CONNECTING TO I PUBLIC SEWER
SEPTIC TANK, SEEPAGE PIT OR wrc: , ...- I OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.. I \ 1 I
AUTHORIZATION TOTAL FEE
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD- ING TO THE PUBLIC SEWER.
SIGNED THIS DAY OF OWNER OR OWNER'S AGENT
OF PERMITTEE
ERTY- SIGNATURE
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. @ 4" = - 6" = -
Add. Horiz. @ 4" = - 6" =
Add. Vert. @ 4" = __ 6" =
Total Construction Cost
Total Lateral i arge
10% Service Charge
Lat. No.: Logged in Plat:
LINE COST DATA
A. D. & Assmt. No.
LINE COST:
C. C. @+ / dwelling
P. S. @- / dwelling
OTHER
w
TOTAL
Grand Total, Lateral, etc. gfl
FOR SEWER LOCATION
/i
st. NORTH
ENGINEERING SEWER DEPT.
Signed I Signed
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issuad By
PERMIT VALIDATION