HomeMy WebLinkAbout2130 BASSWOOD AVE; ; SE646323; Permit---
CITY OF URWAD
' BUILDING DEPARTMENT PERMIT - APPLICATION
FOR APPLICANT TO FILL IN
LEGAL DESCRIPTION Lor NO. ,J< -
BLOCK TRACT ': L. i-- dA LC
USE OF BUILDINGS
CONTRACTOR /[:-- d* __ A b-. ,_ 4 /'. 'Lf -
A3DRESS ,?; a-,' ' ,,/>-,, i
CITY c;, / s, (- TEL NO 2 5 g- ;'?/ 5
CONTRACTOR' S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO. + <> 7 4
NO. DESCRIPTION OF WORK FEE -L__ HOUSE SEWER CONNECTING TO PUBLIC SEWER
SEPTIC TANK, SEEPAGE PIT OR PITS
@ $300
@ $5.00 1 -$ __ I OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. I I CESSPOOL. DRYWELL, MANHOLE @ $5.00
HOUSE SEWER CONNECTING TO
CONP.IEC?- ADDITIONAL ELDG. OR WORK TO HOUSE SEWER
ALTER, REPAIR OR ABANDON HOUSE
PERMIT I TOTAL FEE ' c,
OWNER'S
AUTHORIZATION
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LcCENs CITY OF CARLS- BAD AND SiAV I AM THE LEGAL OWNER OF THE IDENTIAL PROP- ERTY SIGNATURE OF PERMITTEE
BU lLDl NG V
NEAREST
ADDRESS 7 'f.7'. LA-- I. -f -eZY(
CROSS ST -
OWNER ,/; f z . L *- l. .:i , - ,"' /,-/. MAIL ADDRESS
CITY /",, , ~ ,/ ,_ (- TEL. NO. ,< .: '//,',
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. @ 4" = ___ 6" = -
Add. Horiz. 6 4" = - 6" = ___
Add. Vert. @ 4" = __ 6" = __
Total Construction Cost
10% Service Charge
Total Lateral Charge
Lat. No.: - Logged in Plat:
LINE COST DATA
A. D. & Assmt. No.
LINE COST:
C. C. @- / dwelling
P. S. @- / dwelling
OTHER
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
I '
ENGl NEERING SEWER DEPT.
St. NORTH
Signed ] Signed
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By
PERMIT VALIDATION