HomeMy WebLinkAbout1200 CHINQUAPIN AVE; ; SE1965; PermitCITY OF CARUBAD
BUILDING DEPARTMENT
SEWER
PERMIT - APPLICATION
JUL -6-65-lT?6222***** U^.faU
t-u.CO
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO.
BLOCK "7/£ // Xtf ^
/£»^, -fifr^xSig ',-
*4.M-jsi*&*-/n0( / C & /
BUILDINGS <\l~7AJ*-£ f ^ Y" / &T^/ JTQ~)
CONTRACTOR
L ADDRESS
W CITY
CONTRACTOR'S STATE
LICENSE NO.
TEL. NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 9 ,$3.OO
SEPTIC TANK, SEEPAGE PIT OR
PITS ® $5.OO
OVERFLOW SEEPAGE PIT, DRAINF1ELD EXTN.,
CESSPOOL. DRYWELL, MANHOLE @ S5.OO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM & $1.5O
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER 9 $I.SO
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 9 52.OO
9 9
OWNER'S
^ AUTHORIZATION
jl HAVE AT THIS DATE A
CONTRACTOR TO CONNEC
ING TO THE PUBLIC SEW
SIGNED THIS
OWNER OR
ADDRESS
PERMIT $ 2 OO
TOTAL, FEE
CONTRACT WITH THE HEREIN
T THE ABOVE DESCRIBED BUILD-
ER.
DAY <$F
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND
STATE LAWS REGULATING PLUMBING AND SEWERS.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS-
BAD AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL
OWNER OF THE ABOVB^DESCR 1 BED >«£S-IBENTIAL PROP-
ERTY. /JII^J— •*~Pl/'/J//,-
SIGNATURE ( VjMlJ* T-l/JMUtyOF PERMITTEE \,JUf'f
'~ /
«^ p A in
BUILDING . S9 . /*- 7°*J59 ~ CC J?££->" "•••--
ADDRESS / ^£^ff-ey 5 JL*L4sVL^f^f~<-A 4*-*
NEAREST -, S ^f /
CROSS ST. /^?>«/x«L-^.^ ^0 *
OWNER V^ e^f^^^t^^^, st
MAIL <S ~^~ ' -T«
ADDRESS /"
CITY TEL. NO.
CONNECTION DATA
Lateral Charge Computation
30' H.. 10' V. & 4" — h" — //f>,CX>
Add. Vert. / & 4" — A" — ^>fOO
Total Construction Cost / / O tOU
10% Service Charge JJ / 1 '(JJv->
T* l?ty OS*Total 1 ntnral CharrjB / C-*' ' OL»-
Let. No.: . Logged in Plat:
A. D. & Assmt. No. ^- ' b?O /
LINE COST: M
c r. 0 / , ^B.fl ^^.0^
P. S. @ / dwelling
OTHFR if
^^50, CO
Grand Total 1 stnral **$ // -S ' SO
FOR SEWER LOCATION
CO J,
. \ St. A NORTH
EN90NEEKIN* // SEWER DEPT.
Signed DC/ V \^/fAji^\ ^gnnd
^_. ^*"
/This is a Sewer Permit When Properly Filled Out, Signed and Validated
fttuvd By , ., , ,
PERMIT VALIDATION
.