HomeMy WebLinkAbout2140 BASSWOOD AVE; ; SE646325; PermitSEWER
+ BUILDING DEPARTMENT PERMIT - APPLICATION
I FOR APPLICANT TO FILL IN
-- LEGAL DESCRIPTION Lor NO , :a
BLOCK TRACT -/+ / r /A//+
USE OF BUILDINGS
CONTRACTOR ,-Lc - ~ I / J'< .c ~ p. ,+ L L;, /, 9 ~
ADDRESS &Li </, _- ,/[, r.
CITY c', <, I (. i TEL NO -7 -e - ,. 9 >- I CONTRACTOR'S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
*I/- .' i. . ./ w(/ 5 -=/ (,> . * 1.1 6..
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
SEPTIC TANK, SEEPAGE PIT OR PITS @ $5.00
! PUBLIC SEWER
I I OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. I I
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
PRIVATE DISPOSAL SYSTEM @ $1.50
CESSPOOL, DRYWELL. MANHOLE @ $5.00
HOUSE SEWER CONNECTING TO
CONNECT ADDITIONAL BLDG. OR
ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM
WORK TO HOUSE SEWER
I I--+
OWNER'S
AUTHORIZATION I I .I . I I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD- I ING TO THE PUBLIC SEWER.
SIGNED THIS DAY OF OWNER OR I OWNER'S AGENT
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE RE'AD THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS.
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. @ 4" = __ 6" = __
Add. Horiz. @ 4" = __ 6" = __
@ 4" = __ 6" = - Add. Vert.
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
St. NORTH
ENGINEERING SEWER DEPT.
Signed I Signed
I
Issued By
PERMIT VALIDATION