HomeMy WebLinkAbout1070 PALM AVE; ; SE700100; PermitCITY OF CARI.JBI{ SEWER
BUILDING DEPARTMENT PERMIT • APPLICATION
FOR APPLICANT TO FILL IN I
LEGAL BUILDING 1070 I-~ DESCRIPTION LOT NO. ADDRESS
BLOCK TRACT NEAREST
CROSS ST.
USE OF
BUILDINGS OWNER
MAIL
CONTRACTOR ADDRESS
ADDRESS CITY TEL. NO.
CITY TEL . NO. CONNECTION DATA
CONTRACTOR'S STATE CARLSBAD BUSINESS Lateral Charge Computation
LICENSE NO. LICENSE NO. 30' H., 10' V. @ 4" -___ 6" -----
Add. Horiz. @ 4" = ___ 6" -NO. DESCRIPTION OF WORK FEE ----
HOUSE SEWER CONNECTING TO Add. Vert. @ 4" = ___ 6" -
PUBLIC SEWER 0 $3.00 ----
SEPTIC TANK, SEEPAGE PIT OR
PITS 0 $15.00 Total Construction Cost
OVERFLOW SEEPAGE PIT. ORAINFIELD EXTN.,
CESSPOOL, DRYWELL, MANHOLE @ $!5.00 I 0% Service Charge
HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.!50 Total Lateral Charge
CONNECT ADDITIONAL BLDG. OR Lot. No.: Logged in Plat: WORK TO HOUSE SEWER @ $1.!50
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2.00 LINE COST DATA
• $ A. D. & Assmt. No .
LINE COST:
OWNER'S I $ 2 00 C. C. @ __ / dwelling PERMIT
AUTHORIZATION TOTAL FEE P. S. @ __ / dwelling
OTHER I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR T O CONNECT THE ABOVE DESCRIBED BUILD, TOTAL ING TO THE PUBLIC SEWER.
SIGNED THIS DAY OF Grand Total, Lateral, etc.
OWNER OR
OWNER'S AGENT FOR SEWER LOCATION
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT +: +: AND AGREE TO COMPLY W ITH ALL CIT Y ORDINANCES AND V) V)
STATE LAWS REGULATING PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED St. AND/OR LICENSED AS REQU IRED BY THE C ITY OF CARLS-NORTH BAD AND STATE OF CALIFORN IA OR THAT I AM THE LEGAL
...-ffiGINEERING OW NER OF THE ABOVE DESCRIBED RESIDENTIAL PROP-SEWER DEPT. ERTY. ~ned SIGNATURE r I Signed OF PERMITTEE I -,,,
Thl•h~~,.,r, Filled Out, Signed and Validated
Issued By
PERMIT VALIDATION