HomeMy WebLinkAbout1274 MAGNOLIA AVE; ; SE690010; Permit~Ti tf CARLSBD SEWER
BUILDING DEPARTMENT PERMIT. APPLICATION
FOR APPLICANT TO FILL IN
LEGAL EJUILDING " DESCRIPTION LOT NO. ADDRESS I 1
BLOCK TRACT NEAREST <•
CROSS ST. I
USE OF H \. ~ ' l ' BUILDINGS OWNER ~
MAIL C, 1 CONTRACTOR ADDRESS
ADDRESS CITY TEL. N O.
CITY TEL . NO. CONNECTION DATA
CONTRACTOR'S STATE CARLSBAD BUSINESS Lateral Charge Computation
LICENSE NO. LICENSE NO. 30' H., JO' V. @ 4" = ---6" ;:: ---
Add. Horiz. @ 4" = ---6" -NO. DESCRIPTION OF WORK FEE ----
HOUSE SEWER CONNECTING TO -Add. Vert. @ 4" ___ 6" -= PUBLIC SEWER @ $3.00 . ----
SEPTIC TANK, SEEPAGE PIT O R
PITS 0 $!5.00 Total Construction Cost
OVERFLOW SEEPAGE PIT, DRAINFIELO EXTN,, JO% Service Charge CESSPOOL, DRYWELL, MANHOLE @ $5.00
HOUSE SEWER CONNECTING TO Total Lateral Charge PRIVATE DISPOSAL SYSTEM @ SI.SO --CONNECT ADDITIONAL BLDG. OR Lat. No.: Lo22ed in Plat: WORK TO HOUSE SEWER @ $1.50 --ALTER, REPAIR OR A BANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2.00 LINE COST DATA ----
@ $ A. D. & Assmt. No. --LINE COST: ~ -
OWNER'S I PERMIT $ 2 00 C. C. @ __ I dwelling ;. ,.
AUTHORIZATION TOTAL FEE P. S. @ __ / dwelling
OTHER I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD· TOTAL ING TO THE PUB L IC SEWER.
SIGNED TH IS 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 TH E ABOVE IS CORRECT ..: .. AND AGREE TO COMPLY WITH A LL CITY ORDINANCES AND V) V) STATE LAWS REGULATING PLU MB ING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED B Y THE CITY OF CARLS-
BAD AND STATE OF CAL IFORNIA OR THAT I AM THE LEGAL St.
OWNER OF T HE ABOVE DESCRIBED RESIDENTIAL PROP· ENGINEERING SEWER DEPT. ERTY.
SIGNATURE
OF PERMITTEE Signed I Signed
This is a Sewer Permit When Properly Filled Out, Signed end Validated
Issued By --------------------
PERMIT VALIDATION
NORTH