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1145 CARLSBAD VILLAGE DR; ; SE647492; Permit
CITY OF CARLSBAD BUILDING DEPARTMENT SEWER PERMIT - APPLICATION •PAID FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO BLOCK TRACT DI in niMr-c i /-•(/?/// /f /X ^ r^sf */~y/5/S^'BUILDINGS ^ lC-j>\(/ 1 (l/fCs i) / /p'- / '£X^-r CONTRACTOR fc^frfr && J t3frt# ADDRESS //-<?-? S/Jj/C/M/C ^ITY C-icMWfMw&Ho rtofff^y ^CONTRACTOR S STATE CARLSBAD BUSINESS LICENSE NO LICENSE NO NO DESCRIPTION OF WORK FEE 1 HOUSE SEWER CONNECTING TO / PUBLIC SEWER @ $3 OO SEPTIC TANK, SEEPAGE PIT OR PITS @ S3 OO OVERFLOW SEEPAGE PIT DRAINF1ELD EXTNCESSPOOL DRYWELL MANHOLE @ $5 OO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 5O CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ $1 SO ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $2 OO @ $ OWNER'S PERMIT S AUTHORIZATION TOTAL FEe 2 tr oo 00 1 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN 1 CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD ING TO THE PUBLIC SEWER OWNER OR 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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- — n -a SIGNAT^URE^ rf*M (L/LUM ^4 J *LK&C^ BUfLDING t 1 //$""" 1-^= / /)/] ADDRESS / / V y /^, £- /I' ( NEAREST /5 //> /*> / /} jnCROSS ST r( & US fCsO OWNER MAILADDRESS CiTY t Lateral C 30' H , 10 Add Ho Add Ver 10% Serv Let No / 'OO? MS 6, ^^Oi^y L^fi- S^<4 TE»- N0 CONNECTION DATA large Computation V 5B 4" — A" — © 4" — h" — ro Charga 1 nqqoifj in Plat LINE COST DATA A D X A«mt No 1 INF COST C C @ P S @ OTHER _ uo EN TOT A! FOR SEWER LOCATION LO St NORTH G1NEERIN6 SEWER DEPT This is a Sewer Permit When Properly Filled Out, Signed and Validated Issued By PERMIT VALIDATION