HomeMy WebLinkAbout1275 HOOVER ST; ; SE690286; PermitCITY OF CARLSBAD
BUILDING DEPARTMENT
LEGAL
fJ ESCRIPTION
BLOCK
USE OF
BUILDINGS
CONTRACTOR
ADDRESS
CITY
FOR APPLICANT TO FILL ;N
LOT No5w' Co/2..
TRACT
TEL. NO.
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICEt~SE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK. SEEPAGE PIT OR
PITS @ $5.00
OVERFLOW S EEPAGE PIT. DRAINFIELD EXTN.,
CESSPOOL. DRYWELL, MANHOLE ~5.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ SI.SO
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER @ $1.50 --ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2.00
@ $
OWNER'S I PERMIT ___ $ 2
AUTHORIZATION TOTAL FEE
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--
--
--
00 --
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD,
ING TO Tl~E PUBLIC SEWER.
S IGNED THIS -----DAY OF ---------
OWNER OR
OWNER"S AGENT -----------------
ADDRESS
I HEREBY ACKNOWLEDGE THAT J 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.
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 EGAL.
OWNER OF THE ~BO DE R D E DENTIAL ROP-
ERTY.
S IGNATURE
OF PERM ITTEE
SEWER
PERMIT • APPLICATION
:g6LRt;c'rsG / 2 75 CO v'~R_ NEARES~T=-~----'-~-_.__.__-=--=--""'---=------
CROSS ST.
OWNER
MAIL
ADDRESS
CITY TEL.. NO. -
CONNECTION DATA
Lateral Ch-.,ge Computation
30' H., 10' V.
Add. Horiz.
Add. Vert.
@ 4"
@ 4"
@ 4"
---6"
___ 6"
___ b"
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Total Construction Cost ____ _
I 0% Service Charge
Total Lateral Charge ____ _
Lat. No.: ____ _ Logged in Plat:
LINE COST DATA
A. D. & Assmt. No. -l
LINE COST:
C. C. @50grJ dwelling ______ _
P, S. @ __ / dwelling ______________ _
OTHER -------------~$-_-M:-------=--
TOTAL ~oQQ.
Grand Total, Lateral, etc.
FOR SEWER LOCATION
~----------------~
St. NORTH
SEWER DEPT.
Signed ________ _
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By ___________________ _
PERMIT VALIDATION