HomeMy WebLinkAbout2080 BASSWOOD AVE; ; SE646319; PermitBUILDING DEPARTMENT PERMIT - APPLICATION
SEWER OR DISPOSAL SYSTEM @ $2.00
@Jb
FOR APPLICANT TO FILL IN
.+
LEGAL DESCRIPTION LOT NO ~q'L7
BLOCK
USE OF BU ILDl NGS
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TRACT 7 ~2~ hi &/&
CONTRACTOR t-4- &f -c. c.,c b' ++ri & L,
ADDRESS 26 c // &?z z'--
CITY &ld ,pa-&'- TEL. NO. > 3 9 - -I ?/ST
CONTRACTOR'S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
L; 4
NO. DESCRIPTION OF WORK FEE
/ HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00
SEPTIC TANK. SEEPAGE PIT OR -
OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN ,
CESSPOOL, DRYWELL. MANHOLE @ $5 00
HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @' $1 50 __
CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER
ALTER REPAIR OR ABANDON HOUSE
OWNERS
AUTHORIZATION
I HAVE Ar 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 APPLlCZTi6N 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-
OWNER OF THE ABOaDESCRiBED AE~IDENT~AL PROP BAD AND STATE OF CA ORNIA OR THAT I AM THE LEGAL
E RTY. SIGNATURE OF PERMITTEE
BUILDING
NEAREST CROSS ST.
ADDRESS - 7 /i dgr. 4 - i c 8 Z' L-..L
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. @ 4" = __ 6" = -
Add. Horiz. @ 4" = __ 6" = __
Add. Vert. @ 4" = __ 6" = __
Total Consfruction 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. 8- / dwelling
OTHER
TOTAL
Grand Total. Lateral. etc.
-
FOR SEWER LOCATION
S f. NORTH
ENGINEERING SEWER DEPT.
Signed 1 Signed
This is a Sewer Permi) When Properly Filled Out, Signed and Validated
Issued By
PERMIT VALIDATION