HomeMy WebLinkAbout1251 KNOWLES AVE; ; SW691803; PermitCITY OF CARllBAD
BUILDING DEPARTMENT
FOR APPLICANT TO FILL IN
LEGAL DESCRIPTION LOT NO.
BLOCK TRACT
USE OF
BUILDINGS
CONTRACTOR
ADDRESS
C ITY TEL. NO.
CONTRACTOR"S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ S3.00 ... ------..,-SEPTIC TANK. SEEPAGE PIT OR
PITS @ $5.00
OVERFLOW SEEPAGE PIT, DRAINFIELO EXTN.,
CESSPOOL, ORYWELL, MANHOLE @ $5.00
HOUSE SEWER CONNECTING TO
PRIVATE D ISPOSAL SYSTEM @ S1.50
CON NECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER @ S 1.50
ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $2.00
@ s
OWNER'S I PERMIT s 2
AUTHORIZATION TOTAL FEE
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00
I H AVE AT THIS DATE A CONTRACT W ITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD·
ING TO THE PUBLIC SEWER.
SIGNED THIS -----DAY OF ----'--------..--OWNER OR OWNER'S AGENT -----------------
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPL ICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY W ITH 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 ABOVE DESCRIBED RESIDENTIAL PROP..
ERTY. SIGNATURE
OF PERMITTEE
SEWER
PERMIT -APPLICATION
DUILDING
ADDRESS
NEAREST
CROSS ST.
OWNER
MAIL ADDRESS
CITY
Jc,L Z.Z -r,, J -:fl / ~ o 3
T EL. NO.
CONNECTION DATA
Lateral Charge Computation
30' H., 10' V. @ 4" = ---6" ----
Add. Horiz. @ 4" = ___ 6" ----
Add. Vert. @ 4" = ___ 6" ----
Total Construction Cost
10% Service Charge
Total Lateral Charge ____ _
Lot. No.: Logged in Plot:
LINE COST DATA
A. D. & Assmt. No. ________________ _
LINE COST: _______________ _
C. C. @ __ / dwelling ____________ _
P. S. @ __ / dwelling _____________ _
OTHER
TOTAL
Gra nd Total, Lateral, etc.
FOR SEWER LOCATION
~-----------------1~
St.
ENGINEERING SEWER DEPT.
NORTH
Signed ________ _
This is • Sewer Permit When Properly Filled Out, Signed end Validated
Issued By ----------------,------
PERMIT VALIDATION