HomeMy WebLinkAbout1415 FOREST AVE; ; 65-8043; PermitCITY OF CARLSBAD SEWER
BUILDING DEPARTMENT 80~3 PERMIT. APPLICATION
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO.
BLOCK
USE OF
BUILDINGS
CONTRACTOR
ADDRESS
CITY TEL. NO.
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO PUBLIC SEWER 0 $3.00 ..:/'__
~~T71c TANK, SEEPAGE PIT ORO SIS.00
OVERFLOW SEEPAGE PIT, DRAINl'll!LD EXTN.,
Cl!88POOL, CIRYWELL, MANHOLII • $15.00
HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 0 SI.ISO
CONNECT ADDITIONAL BLDG. OR WORK TO HOUSE SEWER • SUJO
ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 0 $2.00
• •
OWNER'S I PERMIT s 2
AUTHORIZATION TOTAL P'EIE 5'
/
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I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD·
ING TO TH E PUBLI C 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 AG~EE 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. m t ~ SIGNATURE A J OF PERMITTEE g....-'k -,"
RI 17-65 ~';:07907*******5.00
OWNER
MAIL ADDRESS
CITY
CONNECTION DATA
Lateral Chargs Computation
30' H., 10' V. @ 4" = 6" --------
Add. Horiz. @ '4" = 6" -------
Add. Vert. @ '4" = ___ 6" = ---
Total Construction Cost
10% Service Charge
Lat. No.:
Total Lateral Chorge -----
Logged in Plot:
llNE COST DATA
A. D. & Assmt. No. ----------------
LI NE COST: ----------------
C. C. @ __ / dwelling -------------
P. S. @ __ / dwelling -------------
OTHER
TOTAL
Grond Total, Loterol, etc.
FOR SEWER LOCATION
NORTH
ENGINEERING SEWER DEPT.
Signed ---------Signed ---------
Signed and Validated This is • Sewer Permit When Properll Filled Out,
Issued By -~l"------------------
PERMIT VALIDATION