HomeMy WebLinkAbout1435 FOREST AVE; ; 65-8782; PermitCITY OF CARUBAD BUILDING DIPARTMENT
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO.
BLOCK
USE OF
BUILDINGS
CONTRACTOR
ADDRESS
CITY
TRACT
TEL. NO.
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BU81NES8
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ;;;
PUBL IC SEWER • '3.00
SEPTIC TANK, SEEPAGE PIT OR
PITS 0 115.00
OVERFLOW SEEl"AGE PIT, DRAINP'lll:LD 11:llTN.,
CESSPOOL. DRYWELL, MANHOLE • ss.oo
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM • SI.ISO
CON NECT ADDITIONAL BLDG. OR WORK TO HOUSE SEWER O SI.ISO
ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM • S2.00
• •
OWNER'S I PERMIT • 2
.· AUTHORIZATION TOTAL FEE
87
oa
,__
00
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 APPL ICATION 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
BUILDING
ADDRESS
NEAREST
CROSS ST.
OWNER
MAIL
ADDRESS
CITY TEL. NO.
CONNECTION DATA
L..teral Charge Computation
30' H., 10' V. @ 4" = __ b" ___ -----
Add. Horiz. @ 4" = __ b" ___ -----
Add. Vert. @ 4" =
I 0% Service Charge
Lat. No.: __
___ t," ----------
Total Lateral Charge-----
Logged in Plat:
LINE COST DATA
A. D. & Assmt. No.----....,...-----------
LINE COST: ------------·1·-z-----
C. C. ®-/dwelling ------------
P. S. ®--I dwelling -------------
OTHER -------------------
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
ili ----------------.:::;
St. NORTH
ENGINEERING SEWER DEPT.
Signed ----------Signed ---------
This is a s.-, Permit When Properly Filled Out, Si9ned and Validated
luued By ---------·----------
PERMIT VALIDATION
CITY OF CARUBAf>
BUILDING DEPARTMENT
LEGAL
DESCRIPTION
BLOCK
USE OF
BUILDINGS
CONTRACTOR
FOR APPLICANT TO FILL IN
ADORE~/"~
TEL. NO.
CONTRACTOR"$ STATE
LICENSE NO. CARLSBAD BUSINESS LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ~ PUBLIC SEWER 0 $3.00
SEPTIC TANK, SEEPAGE PIT OR
PITS 0 .!5.00
OVERFLOW SEEPAGE PIT. DRAINP'IIELD EXTN .•
CESSPOOL. DRYWELL0 MANHOLIE O $!5.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 0 Sl.!50
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER O Sl.!50
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM O $2.00
• s
OWNER'S PERMIT ' 2
AUTHORIZATION .-TOTAL .. IEE
"0
00
C)
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 APPLICATION ANO 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
DEC -2·65 ~P~~
03397*******5.00
CONNECTION DATA
Lateral Charge Computation
30' H., 10' V. @
Add. Horiz. @
Add. Vert. @
JO% Service Charge
Lat. No.:
4"
4"
4"
= --6" =---
= --6"=--
= 6" -------
Total Construction Cost
Total Lateral Charge-----
Logged in Plat:
LINE COST DATA
A. D. & Assmt. No. ---------------
LINE COST: -----------------
C. C. @ __ / dwelling -------------
P. S. @ __ I dwelling -------------
OTHER
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
St. NORTH
ENGINEERING SEWER DEPT.
Signed ---------Signed ---------
This is • Sawer Permit When Properly Filled Out, Signed and Validated
luued By -------------------
PERMIT VALIDATION