HomeMy WebLinkAbout2019 COSTA DEL MAR RD; CONF CTR; 73-1359; PermitBUILDING PERMIT APPLICATION
P.,.,,I 1 1 III I I
^ City of CARLSBAD, CALIFORNIA 92008
^f W%1_ *B f\f^ ^ ^ <%^Applicant to complete numbend spaces only PnOHe 7Z9-llol
8 Class of work DNEW
/*r*
9 Descnbework
ADDITION D ALTERATION D REPAIR D D RfMOy€ /^ / Cj^----- t
10 Change of use from
Change of use to
11 Valuation of work $PLAN CHECK FEE o PERMIT FEE
SPECIAL CONDITIONS Type ot—
Const y
Occupancy
Group Division
Size of
(Total) Sq Ft,".1 <)
No of
Stories
Max
Occ Load
APPLICATION ACCEPTED BY PLANS COCKED BY
V<
APPROVED FOR ISSUANCE BY
Use
Zone C.
Fire Sprinklers
Required Dves
No of
Dwelling Units
OFFSTREET PARKING SPACES
Covered " Uncovered
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB
ING, HEATING, VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC
TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM
MENCED
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECTALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION
Special Approvals
ZONING
HEALTH DEPT
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SOIL REPORT
OTHER (Specify)
.
Required Received Not Required
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SIGNATURE OF OWNER (IF OWNER BUILDER)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M O CASH
INSPECTOR
INSPECTION RECORD
FOUNDATIONS
SET BACK
TRENCH
REINFORCING
FOUNDATION WALL &
WEATHER PROOFING
CONCRETE SLAB
FRAMING
INT LATHING OR DRYWALL
EXT LATHING
MASONRY
FINAL
DATE
7 °n 7f £\J I
REMARKS
1 f\ Tfi U . 1\. .
INSPECTOR
B 4*»T T• jwejison
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC
Footings 6/28/73 No footings executed as required by plans. Do not pour concrete until
this problem is resolved. B, Nelson
7/3/73 Footings. Steel to be 3" From earth, (from bottom of footings & from ends of bais)
Please notify building dept. before pouring concrete, so inspector can be on job during pour.
_ B. Nelson
7/5/73 Footings: pour at 1Q:00 am O.K. B. Nelson
7/11/73 Fdn. Forms O.K. B. Nelson _
8-3-73 Arrived at address 1;4$Concrete piers for porch on 3 sides of bldg."and lower level slab all poured" B. Nelson
9-4-73 Drywall: Protect posts & beams lower level. Protect sill edges lower level.
Plug break out between swithh boxes and complete section abdve to ceiling line.
B~. Nelson
9_5_73 Gas Line; O.K. B. Nelson
. ELECTRICAL PERMIT APPLICATION " ae"
p.m,,t MO *7*T~££) / City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only PhOtlC 729-1181
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jf i* j j *f
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1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THISAPPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECTALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEDHEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOTPRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION
li^^i^^g^ yfT*C*t£*'f >3$»7 '•
SIGNATURE OP CONTRACTOR OR AUTHORIZED ASENT (DATE)
SUHATUM OF OWNER IIP OWNER BUILDER) tOAT«l _ __ _
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Ha
1
1 '•1 J°* ADDMC** 1PERMIT FEES
ISSUANCE OF EACH PERMIT
NEW CONSTRUCTION, FOR EACH
AMPERES OF MAIN SERVICE SWITCH
FUSE OR BREAKER
NEW SERVICE ON EXISTING BLDG
FOR EA AMPERE OF INCREASE
IN MAIN SERVICE, SWITCH, FUSE
OR BREAKER
REMODEL, ALTERATION, NO CHANGE
IN SERVICE, FOR EA AMPERE OF
INCREASE """>?/ '
TEMP SERVICE UP TO AND INCLUD-
ING 200 AMP
TEMP SERVICE OVER 200 AMP
PER 100
MsMHiMMi PERMIT FEE
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WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
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PLUMBING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA
Applicant to compfete numbered spaces only
, LEGAL
1 DESCR
OWNER
2
2100 Coata Del Mar Road, La Co*ta (Hacienda Bldg)
LOT HO
La Co
CONTRACTOR
3 XitM
ARCHITECT OR DESIGNER
4
ENGINEER
5
LENDER
6
USE OF BUILDING
8 Class of Jerk- 1
•LK TRACT
(j |SEE ATTACHED SHEET)
f MAIL ADDRESS ZIP PHONE
»ta Land Co. 2100 Coeta D«l Mar aft. La Cmta, Calif.
MAIL ADDRESS
an»a Pluabinq 6 Htq.. Inc. 694
PHO>*^fefe~^l574 LICENSE NO
AXV4ucaao nts. Mk na*a 9743
MAIL ADDRESS PHOHE LICENSE NO
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MAIL AOBNj^jg^^MM,^^
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• , i- -IUEW. DAJWJITION tp ALTERATION D REPAIR
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THIS PERMIT BECOM
TION AUTHORIZED 1
- CONSTRUCTION OR V
PERIOD OF 120 DA
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1 HEREBY CERTIFYAPPLICATION AND KALL PROVISIONS OFTYPE OF WORK WIL
HEREIN OR NOT, TPRESUME TO GIVE >PROVISIONS OF ANYCONSTRUCTION OR
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ES NULL AND VOID IF WORK OR CONSTRUC-
S NOT COMMENCED WITHIN 60 DAYS, OR IF
VORK IS SUSPENDED OR ABANDONED FOR A
YS AT ANY TIME AFTER WORK IS COM-
THAT 1 HAVE READ AND EXAMINED THISNOW THE SAME TO BE TRUE AND CORRECTLAWS AND ORDINANCES GOVERNING THISL BE COMPLIED WITH WHETHER SPECIFIEDHE GRANTING OF A PERMIT DOES NOT
AUTHORITY TO VIOLATE OR CANCEL THE
OTHER STATE OR LOCAL LAW REGULATINGTHE PERFORMANCE OF CONSTRUCTION
R~8R fc>rybT«rzED AGENT (DATE) j *
OWN EH SUILDER) (DATE)
<
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^^^
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3 5c
Vin
PERMIT FEES
No
M1f\
\
Type of Fixture or Item
WATER CLOSET (TOILET)
BATHTUB
LAVATORY (WASH BASIN)
SHOWER
KITCHEN SINK & DISP
DISHWASHER
LAUNDRY TRAY
CLOTHES WASHER
WATER HEATER
URINAL
DRINKING FOUNTAIN
FLOOR— SINK Ol^bRHlM^
SLOP SINK
GAS SYSTEMS NO OUTLETS
WATER PIPING & TREATING EQUIP
WASTE INTERCEPTOR
VACUUM BREAKERS
LAWN SPRINKLER SYSTEM
SEWER
CESSPOOL
SEPTIC TANK & PIT
PERMIT $
TOTAL FEE $
Fee
$ (Q
4
1
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QU
£jC
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WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
(D
3
0
RMRR;Sir
-
i
3
PLAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION CK M O CASH
INSPECTOR
INSPECTION REPORTS
DATE
U20-73
12-12
ITEM
Partial copper pori
Gas line
REMARKS
ion O.K.
O.K.
-
INSPECTOR
B. Nelson
B. Nelson
-
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC
PERMIT JON
PHI* Nn?3- .*.>-.* i. C«y of CARLSBAD, CALIFORNIA
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3
ARCHITECT OR BEttMCR MAIL ADORES* PHONE LICENSE HO
4
ENGINEER MAIL ADDRESS
5
RHONE LICENSE NO.
~
LENDER MAIL ADDRESS (RANCH
6
USE OF DUILDINC
7
8 Ctanofwork: DNEW D ADDITION D ALTERATION D REPAIR
9 Dtsctibtwork:
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&tlfr**S'* <s& - Cvtf^x "^
SPECIAL CONDITIONS
Aff LICATIOW AOCErrjO BY FLANS CHECKED BY APPROVED FOR ISSUANCE BY
<^NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHOR«ZEO IS NOT COMMENCED WITHIN 60 DAYS. OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECTALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEDHEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOTPRESUME TO OlVk AUTHORITY TO VIOLATE OR CANCEL THEPROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION
-
• IOHATURE Of CONTRACTOR OR AUTHORIZED ACENT (DATE)
f ISNATUU Of OflMM lir OWNER MULDER) (DATE)
<
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8
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PERMIT FEES
No
-
Typ» of Fixtun or Item
WATER CLOSET (TOILET)
BATHTUB
LAVATORY (WASH BASIN)
SHOWER
KITCHEN SINK «• DISP
DISHWASHER
LAUNDRY TRAY
CLOTHES WASHER
WATER HEATER
URINAL
DRINKING FOUNTAIN
FLOOR— SINK OR DRAIN
SLOP SINK
GAS SYSTEMS NO OUTLETS
WATER PIPING & TREATING EQUIP
WASTE INTERCEPTOR
VACUUM BREAKERS
LAWN SPRINKLER SYSTEM
SEWER
CESSPOOL . . ..
SEPTIC TANK & PIT
PERMIT $
TOTAL FEE $
Foe
$
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$*K
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WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS » YOUR PERMIT
PLAN CHECK VALIDATION CK.MO CASH PERMIT VALIDATION CK.M.O.CASH
INSPECTOR
INSPECTION REPORTS
DATE ITEM REMARKS INSPECTOR
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QIOftOE R (AUNOfflS ASSOCIATE STRUCTUIAl fNGINECtS
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I SAUMOftS ASSOCIAtIS STDUCTUkAL PAGE
BENTON ENGINEERING, INC
APPLIED SOIL MECHANICS FOUNDATIONS
4342 FAIRMQUNT AVENUE
PHILIP HCNKINQ BENTQN BAN DIIOQ 5, CALIFORNIA
PRESIDENT - CIVIL CNOINEEM MdV 26, 1964 ATWATER 1-5 S B 1
Rancho La Costa, Inc.
Route 1, Box 2550
Encinitas, California
Attention: Mr. Irv Roston
Subject: Project No. 63-10-2D
Report on Compacted Filled Ground
Placed on Certain Areas of the
Proposed Cabanas F-l to F-4, inclusive,
F-7 to F-9, inclusive, and H-3 and H-4,
and on Certain Areas of the Proposed
Model Home Lots 125 to 128, inclusive
Rancho La Costa
San Diego County, California
Gentlemen:
This is to report the results of tests and observations made in order to inspect and test the
compaction of filled ground placed on certain areas of the proposed Cabanas F-l to F-4,
inclusive, F-7 to F-9, inclusive, and H-3 and H-4, and on certain areas of the proposed
Model Home Lots 125 to 128, inclusive, of Rancho La Costa, San Diego County, California.
The fills were placed during the period between November 14, 1963 and January 10, 1964.
i
The approximate areas and depths of filled ground placed under our inspection are shown on
the attached Drawing No. 3, entitled "Location of Compacted Filled Ground". The grading
plan used for the placement of filled ground, entitled "Club House Area Grading Plan" was
prepared by Engineering Service Corporation dated September 20, 1963 and revised October
22, 1963. The approximate locations at which the tests were taken and the final test results
are presented on pages 4 and 5 under "Table of Test Results". The laboratory determinations
of the maximum dry densities and optimum moisture contents of the major fill materials are
presented on page 5 under "Laboratory Test Results". The tests were taken during the weekly
periods indicated below:
Test Number Week Ending
1 November 16, 1963
2 to 6, inclusive November 23, 1963
7 to 9, inclusive December 14, 1963
10 to 16, inclusive December 21, 1963
17 to 38, inclusive December 28, 1963
39 to 41, inclusive January 4, 1964
42 to 44, inclusive January 11, 1964
Project No. 63-10-2D -2- May 26, 1964
Rancho La Costa
All vegetation was removed prior to filling and the exposed natural ground was then scarified,
moistened to near optimum, and then compacted to at least 90 percent of the maximum dry
density to provide a suitable base for the compacted filled ground. All sloping terrain was
benched horizontally to provide a level base for the filled ground.
All compacted filled ground referred to in this report was composed of non-expansive fill
soils. However, in that none of the natural expansive clay soils were excavated in any of the
cabana or model lot areas to provide two feet of compacted non-expansive filled ground in
the building areas, it is recommended that the footing trenches be examined, when they have
been excavated, to determine whether or not special foundation design will be required. No
special foundation design will be required for the proposed one story buildings if the upper two
feet of soil within the building areas is entirely non-expansive.
If the upper two feet of soil below finished grade is not composed of non-expansive soils, then
the following special foundation design is recommended for the proposed one story structures to
minimize the effect of possible differential movements.
1. Continuous wall footings should be used throughout and these should be founded at
18 inches below the lowest adjacent finished grade.
I/ The footings should also be reinforced with one No. 4 steel bar placed 3 inches
above the bottom of the footing and one No« 4 steel bar placed at 1 1/2 inches below the top
of the stem wall of the footing.
^"^ 2. Where concrete slab floors are to be placed on grade, these should have a minimum
of 4 inches of sand placed between the concrete and the expansive soil and the slabs should be
reinforced with 6" - 6" by ^10 - ^10 wire mesh.
^ 3. Any garage slabs should be separated from the exterior wall footings by 1/4 inch
thickness or greater of expansion joint material to permit the slabs to move relative to the
foundations without excessive cracking.
4. Field moisture checks should be made three weeks ahead of any scheduled pouring of
concrete slabs in order to verify that sufficient moisture exists in any expansive soils to prevent
excessive upheaval pressure. If insufficient moisture exists then water should be introduced by
some suitable means.
The final results of the tests and observations indicate that the compacted filled ground shown
within the shaded areas on Drawing No» 3 has been uniformly compacted to at least 90 percent
of the maximum dry density. It has been determined that the fill materials, compacted to 90
percent of the maximum dry density, have a safe bearing value of at least 1500 pounds per square
foot for one foot wide continuous footings founded at a minimum depth and placed five feet or
BENTON ENGINEERING, INC
Project No. 63-10-2D
Rancho La Costa
-3-May26, 1964
more inside the top of compacted filled ground slopes. If footings are placed closer to the
exposed 1 1/2 horizontal to 1 vertical slopes than 5 feet inside the top of compacted filled
ground slopes, these should be deepened one foot below a 1 1/2 horizontal to 1 vertical line
projected outward and downward from a point 5 feet inside the top of compacted filled ground
slopes. Tests indicate that the compacted filled ground is adequate to satisfactorily support
the proposed one story wood frame dwellings. If the proposed one story buildings are founded
on two feet of non-expansive compacted filled ground and/or non-expansive natural soil with
conventional footings, or on expansive clay soils with the special foundation design as
recommended, then no detrimental movements should occur.
Respectfully submitted,
BENTON ENGINEERING, INC.
lilip Hf Benton, Civn Engineer
cc: (1) Engineering Service Corporation
BENTON ENGINEERING, INC
Project No. 63-10-2D
Rancho La Costa
-4-May26, 1964
TABLE OF TEST RESULTS
Test
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Lot
No.
126
126
127
126
127
128
Cabana F-9
Cabana F-9
Cabana F-7
Cabana F-2
Cabana F-2
Cabana F-2
Cabana F-4
Cabana F-9
Cabana F-2
Cabana F-2
Cabana F-4
Cabana H-4
Cabana H-4
128
127
125
Cabana F-l
Cabana F-l
Cabana H-3
Cabana H-3
Cabana F-4
Cabana F-4
Cabana F-4
Cabana F-4
Cabana F-3
Cabana F-l
Cabana F-4
Cabana F-3
Cabana F-l
Depth
of Fill
at Test
in Feet
2
4
2
6
4
2
2
4
2
2
4
6
2
6
8
10
4
2
4
4
6
1
2
4
1
3
6
8
10
12
2
6
14
5
8
Field
Moisture
% dry wt
7.3
11.9
11.1
11.3
11.0
13.3
15.4
12.0
15.5
14.0
13.7
13.3
14.1
8.6
12.1
15.0
14.8
12.1
16.9
11.2
14.5
12.4
14.6
14.8
12.8
8.3
10.2
11.1
9.7
9.5
12.5
13.4
12.4
11.4
11.1
Dry
Density
Ib/cuft
116.9
115.5
104.3
106.1
107.5
112.9
109.7
108.9
111.4
113.2
110.0
109.3
110.0
113.8
104.3
94,4
108.5
105.3
108.9
111.8
115.0
106.4
102.8
103.5
98.3
103.6
105.0
106.7
104.4
113.3
99.0
98.4
113.5
102.8
102,9
Maximum
Dry
Density
Ib/cu ft
123.2
123.2
114.2
114.2
115.7
123.2
114.0
120.4
123.2
123.2
114.0
114.0
120.2
121.8
111.2
99.3
117.3
114.2
117.3
119.1
123.2
118.2
105.2
105.2
99.3
113.6
114.0
114.0
114.2
121.9
106.4
106.4
121.9
113.6
113.6
Percent
Compaction
94.8
93.8
91.4
92.8
93.0
91.5
96.2
90.5
90.4
91.8
96.4
95.8
91.4
93.3
93.8
95.1
92.4
92.2
92.8
93.8
93.4
90.0
97.7
98.3
99.1
91.1
92.0
93.5
91.4
93.0
93.0
92.5
93.0
90o5
90.6
Remarks
BENTON ENGINEERING INC
Project No. 63-10-2D
Rancho La Costa
-5-
TABLE OF TEST RESULTS (CONT)
May 26, 1964
Test
No.
36
37
38
39
40
41
42
43
44
Lot
No.
Cabana F-4
Cabana F-2
Cabana F-2
Cabana F-7
Cabana F-8
Cabana H-3
Cabana H-4
Cabana H-3
Cabana H-4
Depth
of Fill
atTest
in Feet
18
12
14
3
3
5
6
6
8
Field
Moisture
% dry wt
11.9
10.3
9.9
12.7
12.0
14.0
14.1
13.7
16.2
Dry
Density
Ib/cu ft
110.7
109.8
110.4
115.5
118.8
118.2
106.3
114.2
113.3
Maximum
Dry
Density
Ib/cu ft
121.9
120.2
111.2
123.2
123.2
123.2
113.6
123.2
123.2
Percent
Compaction
90.8
91.4
99.2
93.6
96.4
95.9
93.6
92.6
91.9
Remarks
LABORATORY TEST RESULTS
The maximum dry densities and optimum moisture contents of the major fill materials as
determined by the A.A0S.H.O. T99-49 method of compaction, modified to use 26 blows of
a 10 pound hammer falling from a height of 18 inches on each of 3 layers in a 4 inch diameter
1/30 cubic foot compaction cylinder, are presented as follows:
Soil Type
Brown silty fine sand with clay binder
Light yellow gray silty fine sand and sandy silt
Light gray silty fine sand
Light gray silty fine to coarse sand with 10% gravel
Brown silty fine sand
Dark gray clayey silt
Light gray brown silty fine sand
Brown and red brown silty fine sand with clay binder
and clay lumps
Red brown silty clay
Gray yellow silty very fine to fine sand
Light brown and medium brown clayey fine to medium
sand with clay lumps and lime streaks
Maximum
Dry
Density
Ib/cu ft
123.2
114.2
117.3
121.2
121.8
105.2
113.6
121.9
114.0
99.3
119.1
Optimum
Moisture
Content
% dry wt
10,5
15.4
13.2
12.5
11.6
19.5
13.5
11.6
15.4
17.6
13oO
BENTON ENGINEERING, INC
BENTON ENGINEERING, INC.
APPLIED biOIL. MECHANICS — FOUNDATIONS
U7I7 CONVOY COUS
N DIEGO CAi_iKORNIA
TELEPHONE. (714) 5t>5 1933
1, 1973
La Costa Lend Company
Ccifa Dal /V.ar Road
C-jrJi3od, California 92008
Ai7-?nrion: AV, Roberf Stork
Projacr f 'o. 73-3-5F
Inspection of hoofing
Excavafions Hacienda Building
Rancho La Cosfa
Carlsbad, Caiiromia
Cenrlarren;
!;-3 '2xc<r/arion for the pier (borings fhof support fhe norrh '.vood'en porch on I he Hocfsndo Building
ouih of fhs La Cosfa Clubhouse were deepened one fool" into firm narurcl ground cs derermined by
by a raprssenrarivs of 3-anron Engineering, Inc.
?.^\peci-rui!y submi^ed,
^iZNTQN ENGINEERING, INC.
(^^^;^~^v/^---: ^ i^^-^^*^^"FSilip H.'ienhon/ Ctvii engineer
i^rr; (3) Addressee
RECEIVED
AUG101973
CITY Ot- CAiJLbdAD
Engineering Department
?H3/m«g
Owner's Name
Mailing Address
Job Address .
SERVICE REQUESTED
LEUCADIA COUNTY WATER DISTRICT
APPLICATION FOR SEWER SERVICE
La Costa Land Company
Costa Del Mar Road
Carlsbad, California
Receipt No 3157
Phone No
Hacienda Meeting Room Recreation _Area_
Rancho La Costa, Carlsbad, Calif.
CONNECTION CHARGE
for Single Unit (type of building)
COST
300.00
If a multiple unit building, indicate no of living units
SERVICE LATERAL /X^?>7>C- / ?*'$f>_f>
If service lateral previously installed - No Foe
If service lateral required
Check size lateral required
(4") (6") Other
SURCHARGE FEE 100.00
Saddle connection required
TOTAL CHARGES
Yes..No.
Amount Rec'd $400.00
How Paid Ck.#4330
Date Paid 9-4-73
Rec'd by C.Bartkiewicz
<? •j^'t.Ar'T^rtTjo 400.00
The application must be signed by the owner (or his authorized representative) of the property
to be served. The total charges must be paid to the District at the time the application is
submitted
If a service lateral is required, it will be installed by the Leucadia County Water District.
The service lateral is that part of the sewer system that extends from the main collection line
in the street (or easement) to the point in the street (at or near the applicant's property line)
where the service lateral is connected to the applicant's building sewer.
The applicant is responsible for the construction, at the applicant's expense, of the sewer
pipeline (building sewer) from the applicant's plumbing to the point in the street (or easement)
where a connection is made to the service lateral
The connection of the applicant's building sewer to the service lateral shall be made by the
applicant at his expense The connection must be made in conformity with the District's
specifications, rules and regulations, .ancLrLjmusjtJbe inspected, and approved by the District
before the sewer system may be used by the applicant The applicant, or his authorized rep-
resentative, must notify the District at the time inspection is desired. Any connection made
to the service lateral or collection line without prior approval and inspection by the District
will be considered invalid and will not be acknowledged
After connection is complete, the property described above is subject to a monthly sewer serv-
ice charge The rate will be governed by the use of the property - residential, commercial, or
multiple dwelling. Non-payment of the sewer service charge is subject to a 5% penalty per
month, plus disconnection if necessary
The undersigned hereby agrees that the above information given is correct and agrees to the
conditions as stated
Owner's Signature /Date