HomeMy WebLinkAbout1370 BUENA VISTA WAY; ; SE668996; PermitBUILDING DEPARTMENT PERMIT - APPLICATION
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DESCRIPTION LOT NO.
CONTRACTOR
TEL. NO.
CONTRACTOR'S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO. I
I I
I t--l---
PERMIT $1 2lm-
TOTAL FEE I OWNER'S
AUTHORIZATION I
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUIW- ING TO THE PUBLIC SEWER.
SIGNED THIS DAY 6F
OWNER OR I OWNER'S AGENT
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. @ 4" = - 6" = -
Add. Horiz. @ 4" = - 6" = -
Add. Vert, @ 4" = ___ 6" = -
Total Construction Cost
10% Service Charge
Total Lateral Charge
Lat. No.: Logged in Plat:
LINE COST DATA
A. D. & Assmt. No.
LINE COST: \
C. C. @A / dwelling^
P. S. @-...--- / dwelling
OTHER
\
TOTAL \
Grand Total, Lateral, etc.
FOR SEWER LOCATION
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE RGAD THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE ro COMPLY WITH ALL CITY ORDINANCES AND REGULATING PLUMB1 CERTIFY THAT I AM NSED AS REQUIRED
rly Filled Out, Signed and Validated
4n $1 /i
I I st. NORTH
ENGINEERING SEWER DEPT.
Signed 1 Signed ,
luurd By -_ PERMIT VAL1 DATl 0 N
. _I