HomeMy WebLinkAbout1339 BUENA VISTA WAY; ; SE694789; PermitBUILDING DEPARTMENT s PERMIT - APPLICATION
FOR APPLICANT TO FILL IN
LEGAL DESCRIPTION Lor NO.
BLOCK TRACT
USE OF BU 1 LDI NGS
CONTRACTOR Lp-c&/AIF, iz,
ADDRESS
CITY TEL. NO.
CONTRACTOR’S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
@ $5.00 __ OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.,
CESSPOOL, DRYWELL, MANHOLE @ $5.00
HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.50 __
CONNECT ADDITIONAL BLDG. OR
ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM
PUBLIC SEWER
SEPTIC TANK, SEEPAGE PIT OR PITS
WORK TO HOUSE SEWER 6’ $1.50 -
@$ I_/-
OWNER‘S
AUTHORIZATION
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD- ING TO THE PUBLIC SEWER.
SIGNED THIS DAY OF
OWNER OR OWNER‘S AGENT
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
AND AGREE TO COffiPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED /OR LICENSED AS REQUIRED BY THE CITY OF CARLS- AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP ERTY. SIGNATURE
mPLicA-rior-4 AND STATE THAT THE ABOVE IS CORRECT
OF PERMITTEE
9 BCJb#.JP BUlLDlNG 2 ADDRESS
NEAREST CROSS ST. p-* #--E*> &3/CO
OWNER &!#cfc [P,/d/36&? ;a”
MAIL ADDRESS 3 88 0 5 b b.i ~3 0 ~3
CITY ---- TEL. NO.
CONNECTION DATA Lateral Charge Computation
30’ H., IO’ V. @ 4” = - 6” = -
Add. Horiz. @ 4” = - 6” = -
Add. Vert. @ 4” = - 6” = -
Total Construction Cost
-
1
4 r,“L-:y
10% Service Charge ff
Total Lateral Charge
Lat. No.: Logged in Plat:
CINE COST DATA
-I A. D. & Assrnt. No.
P. S. @- / dwelling
OTHER
TOTAL /7& %?
Grand Total, Lateral, etc.
FOR SEWER LOCATION
St. NORTH
~~ ENGINEERING
Signed ?fa I Signed
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By
PERMIT VALIDATION