HomeMy WebLinkAbout1390 Forest Ave; ; 65-8213; Permitl
CITY OF CARLSBAD
BUILDING DEPARTMENT
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO.
~~~c;F f E 1 1
TRACT
BUILDINGS ~~ l
,u ~
CITY \.. (';(A..l-..:, (,.. ,;c.,k TEL. NO.
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECT ING TO PUBLIC SEWER O $3.00
SEPTIC TANK, SEEPAGE PIT OR
PITS O $15.00
OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.,
CESSPOOL, DRYWELL. MANHOLE O $15.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM O $1.150
CONNECT ADDITIONAL BLDG. OR WORK TO HOUSE SEWER • $1.150
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM O $2.00
• •
~ /") /'·, -
OWNER'S
AUTHORIZATION
S 2 00 -
TOTAL P'EE c~ or,
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD-
1NG TO THE PUBLIC SEWER.
SIGNED THIS -----DAY OF ----------
OWNER OR
OWNER'S AGENT-----------------
ADDRESS
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. I HEREBY CERTIFY THAT I 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
OF PERMITTEE ----------------
SEWER
PERMIT. APPLICATION
8 I MIR -1-65* '~~o 003* *** * *'.>':>.00
CITY ( {,t.',l.,(_ (,_, /~,:., ( TEL. NO.
CONNECTION DATA
Leterel Cherge Computetion
30' H., 10' V. @ 4" = ___ bH ----
Add. Horiz. @ 4" = ___ bH -----
Add. Vert. @ 4H = ___ b" ----
T otel Construction Cost
10% Service Cherge
lot. No.:
Toto) leterel Cherge -----
Logged in Plet:
LINE COST DATA
A. 0. & Assmt. No. ----------------
LINE COST: -----------------
C. C. @~/ dwelling -'-------
P. S. @ __ I dwelling -------------
OTHER -------------------
TOTAL .--
Grand Tote), Leterel, etc. :->I. 1
FOR SEWER LOCATION
St. NORTH
ENGINEERING SEWER DEPT.
Signed ---------I Signed---------
This is • Sewer Permit When Properly Filled Out, Signed end Velideted
Issued By ---------------------
PERMIT VALIDATION