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HomeMy WebLinkAbout1313 CHINQUAPIN AVE; ; SE647802; PermitCITY Of iUILDING DEPARTMENT 7802 PERMIT - APPLICATION FOR APPLICANT TO FILL IN LEGALDESCRIPTION LOT NO. BLOCK TRACT USE Of BUILDINGS CONTRACTOR Sr~&—/\ (— £< -fT"!?^ J5LA/ <t _ ADDRESS *2$JT/ /T CITY L^^rV^y?/?^) CONTRACTOR'S STATE LICENSE NO. NO. DESCRIPTION OF •> ,Jr73Mrcr- JV— V3&TEL. NO. sec/*7~7S fr0C-J/0 CARLSBAD BUSINESS LICENSE NO. &f*7jF"{~~ WORK FEB/ HOUSE sewen CONNECTING TO/ PUBLIC SCWER • S3.OO SEPTIC TANK. SEEPAGE PIT OR PITS • «.QP OVRft^t-QW SKBPAoe PIT, ORAINFIBLD IXTM., CW»K>?U BRrWKLU. MANHOLE O «-OO HOUSE fSWjRW CONNECTING TO ' PRIVATE DISPOSAL SYSTEM * *1.BO CONNECT ADDITIONAL BLDG. OR ALTER. REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 9 S2.OO • f OWNER'S - AUTHORIZATION 1 HAVE AT THIS DATE A CONTRACTOR TO CON NEC ING TO THE PUBLIC SEW OWNER OR ADDRESS ,- PERMIT 9 TOTAL FEE 3o& 2 OO \5 &® CONTRACT WITH THE HEREIN T THE ABOVE DESCRIBED BUILD- ER. I HEREBY ACKNOWLEDGE THAT 1 HAVE REAP 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 ORrTHAJ-tJAM THE LEGAL OWNER OF THE ABOVE DEKRIBEIX>£8TDENTIAL PROP- ERTY, ^f s/2s&r _. SIGNATURE rsZ?j^~} jC4&£** T—S J /J/*> <*#*/*s<?«+s>'~ & NEAREST CROSS ST. - OWNER y^"^-£-erx-/ /^^<1 J2<Sc*9/1-e~ ILIA It ^"J — .^-^-^ _ ^™"'*^ -^r ^^n *5& ^" ^^ f1 fADDRESS X^C*. & Vr&C. -OCC*/ CITV rtfr€£3/S/&> ***- N0 2&? /Z£3 CONNECTION DATA Lateral Charge Computation W H,, Iff V © 4" — #• — Lat. No.: Loqqed in Plat: LINE COST DATA i IMC rn«!T. P. S. (ft , ,. / ffiu««ll|nfj OTWPR T^TA' FOR SEWER LOCATION St. NORTH ENGINEERING SEWER DEFT. SigrlftH _. . 1 ^!qna^ This U a S»w«r Permit When Properly Filled Out, Signed and Validated lisu«d By PERMIT VALIDATION