HomeMy WebLinkAbout1145 CHINQUAPIN AVE; ; SE646100; PermitCITY OF CARLSBAD
BUILDING DEPARTMENT ~ 6100 SEWER
PERMIT - APPLICATION
FOR APPLICANT TO FILL IN
FCB -6 6M 5~cir 806 00
LEGAL
DEoCRIPTION LOT NO
BLOCK
USE OF
BUILDINGS
CONTRACTOR
BUILDING
ADDRESS
NEAREST
CROSS ST
ADDRESS ;
TEL NO
CONTRACTOR S STATE
LICENSE NO
CARLSBAD BUSINESS
LICENSE NO
NO
/
DESCRIPTION OF WORK
HOUSE SEWER CONNECTING
PUBLIC SEWER
FEE
TO
@ $3 OO
SEPTIC TANK SEEPAGE PIT OR
PITS @ $5 OO
OVERFLOW SEE AGE PIT DRAINFIELD EXTN
CESS OOL DRYWEUL MANHOLE @ $5 OO
HOUSE SEWER CONNECTING
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL BLDG
WORK TO HOUSE SEWER
TO
@ $1 50
OR
@ $1 SO
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2 OO
@ $
OWNERS PERMIT S
AUTHORIZATION TOTAL FEE
3
z
£
GO
OO
oo
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD
I JG TO THE PUBLIC SEWER
SIGNED THIS
OWNER OR
OWNER S AGENT .
DAY OF
ADDRESS -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
API LICATION 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
AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS
BAD AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL
OWNER OF THE ABO><£ DESCRIBgO RESIDENTIAL PROP
ERTY
SIGNATURE
OF PERMITTEE
CITY TEL
CONNECTION DATA
Lateral Charge Computation
30 H 10 V
Add Honz
Add Vert
Total Construction Cost
10 / Service Charge
Lat No
Total Lateral Charge
Logged in Plat
LINE COST DATA
A D & Assmt No ___^
LINE COST
C C @JL_dj / dwellmg
P S @ / dwelling
OTHER
TOTAL
Grand Total Lateral etc
FOR SEWER LOCATION
St NORTH
ENGINEERING SEWER DEPT
Signed Signed
This is a Sewer Permit When Properly Filled Out Signed and Validated
Issued By
PERMIT VALIDATION