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1320 CHINQUAPIN AVE; ; SE1970; Permit
CITY OF BUILDING DEPARTMENT SEWER PERMIT - APPLICATION -7o I FOR APPLICANT TO FILL IN LEGAL . -, - DESCRIPTION LOP NO 2^2 6> — £)&O — tT BLOCK-^ Z<J>-2^y- TRACT A/*f /£ <P/use OF ._, BUILDINGS K&S CONTRACTOR A & £L. ADDRESS CITY CONTRACTOR S STATE LICENSE NO TEL NO CARLSBAD BUSINESS LICENSE NO NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 OO SEPTIC TANK SEEPAGE PIT OR PITS @ $5 OO OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $5 OO' HOUSE SEWER CONNECTING TO / PRIVATE DISPOSAL SYSTEM @ $1 5O CONNECT ADDITIONAL BLDG OR/ ALTER REPAIR OR ABANDON^HOUSE SEWER OR DISPOSAL SYSTEM @ $2 OO / © ? / S OWNERS / AUTHORIZATION 1 HAVE Ajr'THIS DATE ACONTRASTOR TO CONNECING TO'THE PUBLIC SEW SIGNED THIS ^O.WNER OR / ADDRESS "'"*&-. l±£i PERMIT / $ TOTAL FE£ / / X" / / / / 2 OO CONTRACT WITH THE HEREIN T THE ABOVE DESCRIBED BUILD EJjt/ DAY OF /^x' ts±fj&&e*^ i HEREBY/ACKNOWLEDGE THAT i 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 1 HEREBY CERTIFY THAT 1 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 ^^ if yo ADD^EsT / * ^&?/*JQVAP< fJ - £/O 5?&£4 /&/« NEAREST CROSS ST OWNER /*/« t~ £ ' £~K~J t>S 'JS "O £^<9 *\ J^9^dl^/Xr **^ D*ADDRESS S7fO r^rr/c-K- ijff-' CITY ' •TEL NO CONNECTION DATA Lateral Charge Computation 30 H 10 V @ 4' — h" — f/5 — Add Vert @ 4 — Total 10% Service Charge To Lnt No A/ h _ r t t r t //*** tnl lateral Charge/*** Logged in Plat LINE COST DATA A D & Assmt No "2" /'<&/ LINE COST -"~~ C C (5)5^2? / ^wa||m- 1 PS© / dwBl|,no OTHFR Grand FOR SEWER I/) St ENGINEERING Signer! f^ 7V^ff-»f^^~ F1 &A//T O0 — ^* — . TOTAL _ 3& *" LOCATION NORTH SEWER DEPT Signer! Thu is a Sewe^Permit When Properly Filled Out Signed and Validated /-S~<^ Issued By PERMIT VALIDATION