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HomeMy WebLinkAbout2175 CHESTNUT AVE; ; SE1969; PermitCITY OF CARLSBAD BUILDING DEPARTMENT SEWER PERMIT - APPLICATION FOR APPLICANT TO FILL IN LEGAL / ">.PESCRIPTION LOT NO. .'?•**-*«""'•• BLOCK TRACT .-<; *: '•" ,'',t' ,'.•• USE OF BUILDINGS CONTRACTOR ADDRESS CITY CONTRACTOR'S STATE LICENSE NO. TEL. NO. CARLSBAD BUSINESS LICENSE NO. NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 9 $3.OO SEPTIC TANK, SEEPAGE PIT OR PITS 9 $5.00 OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN., CESSPOOL, DRYWELL, MANHOLE 9 S5.OO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 9 *1.5O CONNECT ADDITIONAL BLDG. OR WORK TO HOUSE SEWER 9 $f 5O ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 9 S2.OO 9 $ OWNER'S AUTHORIZATION I HAVE AT THIS DATE A CONTRACTOR TO CONNEC ING TO THE PUBLIC SEW SIGNED THIS OWNER OR ADDRESS — — PERMIT $ TOTAL FEE 2 OO CONTRACT WITH THE HEREIN T THE ABOVE DESCRIBED BUILD- fER. DAY OF 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 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS- BAD AMD STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER «R THE -ABOVE DESCRIBED RESIDENTIAL PROP- SIGNATURE • BUILDINGCI , •— ^«— , / v>.»ADDRESS^/ / / •"> ' f' * j f. AJf. .' f NEAREST . • " .'!-••*-<•• ' / CROSS ST. ,'...'/ •• . i: f) OWNER ; '• : •' , • : MAIL ' ADDRESS CITY TEL. NO. CONNECTION DATA Lateral Charge Computation 30' H., I01 V. <3> 4" — A" — tt«~- <— ArJrl 1 l^rif (R) A" • A" Add. Vert. (S) 4" — h" — 10% Service Charge |.| Vsl Tot-i i -+«r»i ri,,«j. }eH& $& Lat. No.: Logged in Plat: LINE COST DATA A. D. XT Assmt. No. . LINE COST- '",'<1 •' '.; 4t!-&^«f*, <25!3«^4 C. C. 0 / Hilling .'V.-' •fG'Sf P. S. ©__ / dwelling : OTHER ~S^TOTAI ,_?^r]W FOR SEWER LOCATION St. NORTH ENGINEERING SEWER DEPT. Signed •• • ' • • ' '• ' : ,: Siqned _ ,,,,,, 1* tfi f "* ^ ~5 •-. ^t 1! '', 'i f J { This it a Sewer Permit When Properly Filled Out, Signed and Validated Issued By PERMIT VALIDATION °*rJ^-dJ&^am^tm^J^^£l'>- *