HomeMy WebLinkAbout2110 BASSWOOD AVE; ; SE646321; PermitBUILDING DEPARTMENT PERMIT - APPLlCATlON
LEGAL DESCRIPTION Lor NO c/
BLOCK TRACT -94, /<- p . <-.LL'
CONTRACTOR &u c: ae*hi pd??L%-- &G.
ADDRESS 2.t.T 4// dC.7? I
CITY f~~'L-d&&! TEL. NO. -3 ;f -a\??x0.T
USE OF BUILDINGS
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CONTRACTOR'S STATE CARLSBAD BUS1 NESS LICENSE NO. LICENSE NO.
4/3- y'd rL// 44 d,' /
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING
SEPTIC TANK, SEEPAGE PIT OR PITS @ $5.00
/ PUBLIC SEWER
I OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. I I
PRIVATE DISPOSAL SYSTEM @ $1.50 ___ HOUSE SEWER CONNECTING TO
CONNECT ADDITIONAL BLDG. OR
CESSPOOL, DRYWELL, MANHOLE @ $5.00
@ $1.50 __ WORK TO HOUSE SEWER
ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $2.00
AUTHORIZATION TOTAL FEE
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 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. I HEREBV CERTIFY THAT TAM PROPERLY -REGISTERED AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS-
ERTY. SIGNATURE OF PERMITTEE
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. @ 4" = ___ 6" = -
Add. Horiz. @ 4" = - 6" = __
Add. Vert. @ 4" = __ 6" = ____
Total Construction Cost
10% Service Charge
Total Laferal Charge
Lat. No.: Logged in Plat:
LINE COST DATA
A. D. & Assrnt. No.
LINE COST:
C. C. @- / dwelling
P. S. @- / dwelling
OTHER
TOTAL
Grand Tofal, Lateral, etc.
FOR SEWER LOCATION 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