HomeMy WebLinkAbout2070 BASSWOOD AVE; ; SE646317; Permit.- SEWER
, B~M~~~~T PERMIT 0 APPLICATION
LEGAL DESCRIPTION LOT NO. /p
BLOCK TRACT+d&J l//r
USE OF BU ICDINGS
CONTRACTOR csk&u&d /4.c&*ed fk’5
ADDRESS &5-#/ r)
CITY
CONTRAGTOR’S STATL CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
TEL. NO. 73 G? -2 3/a-
NO. I DBgpWtlPTlON OF WORK FEE 1 I HOUSE ‘SEWER CONhECTING TO
PERMIT
TOTAL FEE I OWNER’S
AUTHWUTION
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD. ING TO THE PUBLLC SEWER.
SIGNED THlS DAY OF OWNER OR OWNER’S AGENT
__
1 HfREBY ACKNOWLEDGE THAT I HAVE RECAD THlS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AQREE TO COMPLY WITH ALL CITY ORDINANCES AND ...-- ___ . - - -. - _. STATE LAWS REGULATING PLUMelNG AND SEWERS. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS-
ERTY. SIGNATURE OF PERMITTEE
,-, BUILDING ADDRESS 7.4 3p 7441:
NEAREST CROSS ST
=ITY i :*; L, dc A’ TEL. NO. ,J - -,
CONNECTION DATA Lateral Charge Computation
30’ H., IO’ V. @ 4” = __ 6” = __
60 - Add. Horiz. @ 4” z= __ - _I
Add. Vert. @ 4” = I_ 6” = __
Total Construction Cost
10% Service Charge
Total Lateral Charge
Lat. No.: Logged in Plat:
LINE COST DATA
A. D. & Assrnt. No.
LINE COST:
C. C. @---- / dwelling
P. S. @- / dwelling
OTHER
TOTAL
Grand Total, Lateral, etc.
I/.
FOR SEWER LOCATION
11 I
St. NORTH
ENGINEERING SEWER DEPT.
Signed 1 Signed
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By __
PERMIT VALIDATION