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HomeMy WebLinkAbout2020 CHESTNUT AVE; ; SE679713; PermitCITY OF CARLSBAD* BUILDING DEPARTMENT PERMIT - APPLICATION/^ f^sr tso*******5.oo FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. BLOCK TRACT USE OF BUILDINGS CONTRACTOR <^ d<Jt>Jkj <^ ^ Kl I Ql &~ ADDRESS *.c 9 1 STATE. JT • CITY CONTRACTOR'S STATE LICENSE NO. TEL. NO. CARLSBAD BUSINESS LICENSE NO. NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ ,$3.OO SEPTIC TANK, SEEPAGE PIT OR PITS @ $5.OO OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN., CESSPOOL, DRYWELL, MANHOLE @ S5.OO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ f I.5O CONNECT ADDITIONAL BLDG. OR ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ J2.OO @ 3 OWNER'S AUTHORIZATION I HAVE AT THIS DATE A CONTRACTOR TO CONNEC ING TO THE PUBLIC SEW SIGNED THIS OWNER OR ADDRESS PERMIT 9 TOTAL FEE 3 so 2 00 S °0 CONTRACT WITH THE HEREIN T THE ABOVE DESCRIBED BUILD- ER. DAY <?F - - 1 HEREBY ACKNOWLEDGE THAT 1 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 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS- BAD AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP- ERTY. SIGNATURE WZ3J7 *MI° IW1JIJIJIJIT ''" NEAREST CROSS ST. OWNER r't-GEI^A CLaM6£-E(5AT'OK< (kL. Q^^t^n MAIL ADDRESS CITY TEL. NO. CONNECTION DATA Lateral Charge Computation 30' H.. 10' V. © 4" — h" — Add Hori? © 4" A" Add. Vert. & 4" — h" — <3 (~lf' I Total Constrnrtinri P-n<;t / J<O • 10% Service Charge / 3 ' ^Sr Total Lateral C.hargn /</9'6O Lat. No.: Logged in Plat: LINE COST DATA A. D. » Assmt. No 1 INF COST: C. C. © 5^ / rJwBllm0 IOO.OQ P. S. ©^ _ / rlwBllinrj OTHER . . TOTAI J/00,00 ? ^}ty £/"}Grand Tola!, 1 flt(?ral «tr. S— • * •'•vO^X FOR SEWER LOCATION "> A St. NORTH . ENGINEERING l> SEWER DEPT. Signal (X/. l///^<i'^ I <;!qnar| This is a Sewer Permit When Properly Filled Out, Signed and Validated Issued By PERMIT VALIDATION