HomeMy WebLinkAbout137 MAPLE AVE; ; SE700166; PermitCITY OF CARLSBV SEWER
BUILDING DEPARTMENT PERMIT-APPLICATION
FOR APPLICANT TO FILL IN
LEGAL BUILDING DESCRIPTION LOT NO. ADDRESS /
BLOCK TRACT NEAREST CROSS ST. USE OF
BUILDINGS OWNER
MAIL CONTRACTOR ADDRESS
ADDRESS CITY TEL. NO.
CITY TEL. NO. CONNECTION DATA
CONTRACTOR'S STATE CARLSBAD BUSINESS Lateral Charge Computation
LICENSE NO. LICENSE NO. 30' H., 10' V. @ 4" = ___ 6" =---
NO. DESCRIPTION OF WORK FEE Add. Horiz. @ 4" = ___ 6" =---
HOUSE SEWER CONNECTING TO Add. Vert. @ 4" = 6" -PUBLIC SEWER @ $3.00 -------
SEPTIC TANK, SEEPAGE PIT OR PITS @ $!5.00 Total Construction Cost
OVERFLOW SEEPAGE PIT, ORA.INFIELD EXTN.,
CESSPOOL, DRYWELL, MANHOLE @ S!S.00 10% Service Charge
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.!SO Total Lateral Charge
CONNECT ADDITIONAL BLDG. OR Lot. No.: Logged in Plot: WORK TO HOUSE SEWER @ $1.!SO
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2,00 LINE COST DATA
@ s A. D. & Assmt. No. --LINE COST: -
I s 2 00 C. C. @ __ / dwelling OWNER'S PERMIT
AUTHORIZATION TOT AL FEE P. S. @ __ / dwelling
OTHER I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO C ONNECT THE ABOVE DESCRIBED BUILD, TOTAL ING TO THE PUBLIC SEWER.
SIGNED THIS DAY OF Grand Total, Lateral, etc.
OWNER OR OWNER'S AGENT FOR SEWER LOCATION
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE REA D THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT ..: ... AND AGREE TO COMPLY WITH A L L C ITY ORDINANCES A ND V) V) STATE LAWS REGULATING PLUMBING AND SEWERS. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY THE C ITY OF CARLS-
BAD AND STATE OF CALIFORNIA OR T HAT I AM T H E LEGAL St.
OWNER OF THE ABOVE DESCRIB ED RESIDENTIAL PROP. ENGI NEER ING SEWER DEPT. ERTY.
SIGNATURE
OF PERMITTEE Signed ---I Signed
This is • Sewer Permit When Properly Filled Out, Signed and Valideted
Issued By --------------------
PERMIT VALIDATION
NORTH