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HomeMy WebLinkAbout1303 CHINQUAPIN AVE; ; SE658075; PermitCITY Of CARLSBAD BUILDING DEPARTMENT 8075 SEWER PERMIT - APPLICATION FOR APPLICANT TO FILL IN CONTRACTOR S STATELICENSE NO CARLSBAD BUSINESSLICENSE NO NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 9 SEPTIC TANK SEEPAGE PIT OR PITS 9 OVERFLOW SEEPAGE PIT PRAINFIELD CESSPOOL, DRYWELL MANHOLE 9 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 9 CONNECT AbDmC-NAL BLDG OR WORK TO HOUSE SEWER 9 $300 $000 EXTN$800 $1 SO $1 SO ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 9 $2 OO 9 $ OWNER'S PERMIT *^ AUTHORIZATION TOTAL FEE 2 OO . HAVE AT THIS DATE A CONTRACT WITH THE HEREINCONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD INC TO THE PUBLIC SEWER SISNED THIS ,rr-OWNER OR OWNER S AGENT . ADDRESS . . ,. DAY OF I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRRCT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES ANDSTATE LAWS REGULATING PLUMBING AND SEWERSI HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY THE CITY 'BAD AND STATE OF CALIFORNIA OR THAT I AM 'OWNER OF THE ABOflE DESCRIBED RESIDEhERTY 7/ f . fl •) / <-SIGNATURE /*x>.^ ,^»f Ayr -iL-A/t.V^L^' ,OF XSSK.!OP- CONNECTION DATA Lateral Charge Computation 30 H 10 V Add Honz Add Vert 4" = 4" = 4" = 6" = 6" = 6" = //5.00 6,00 10% Service Charge Lat No Total Construction Total Lateral Charge Logged in Plat A D & Assrat No LINE COST C C © ,,./., / dwelling P S @ / dwelling . OTHER LINE COST DA1A /*""~> Z.-I9&I US " Grand Total Lateral I/O FOR SEWER LOCATION trt St NORTH ENGINEERING SEWER DEPT | Signed Thu is a Sewer Permit When ProperM Issued By PERMIT VALIDATION