HomeMy WebLinkAbout220 Olive Ave; ; SE680038; PermitCITY OF CARUBAD
BUILDING DEPARTMENT
FOR APPLICANT TO FILL IN
LEGAL DESCRIPTION LOT NO.
BLOCK
USE OF
BUILDINGS
CONTRACTOR
CITY
CONTRACTOR'S STATE
LICENSE NO.
TRACT
TEL. NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
/ HOUSE SEWER CONNECTING TO ~' rY"\ PUBLIC SEWER • 13.00
SEPTIC TANK, SEEPAGE PIT OR
PITS 0 115.00
OVERFLOW SEEPAOE ,-1T, DRAINP'l&LD EXTN .•
C£SSPOOL, DRYW~LL, MANHOLll O 115.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 0 Sl.150
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER O SI.SO
ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM O $2.00
• •
OWNER'S I PERMIT s 2 00
AUTHORIZATION TOTAL P'IEIE .t=j' ~
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
SEWER
PERMIT • APPLICATION
OWNER
MAIL
ADORES
CITY TEL. NO.
CONNECTION DATA
Lateral Chsrge Computation
30' H., 10' V. @ 4" = --6"=--
Add. Horiz. @ 4" = __ 6"=--
Add. Vert. @ 4" = __ 6"=--
Total Construction Cost
10% Service Charge
Total Lateral Charge ____ _
Lat. No.: Logged in Plat:
LINE COST DATA
A. 0. & Assmt. No. --------lr---------
LINE COST: #,,//,.__ __ _
C. C. @_.......-_ / dwelling -+-1"--:::-,,,C----¾0
P. S. @ __ / dwelling -:-.,...:L-..._~.....,1---____ _
OTHER ---------~~~---Qo-1 ____ _
Grand Total, Lateral, etc.
FOR SEWER LOCATION
St. NORTH
ENGINEERING SEWER DEPT.
Signed ________ _ Signed ________ _
Properly Filled Out, Signed snd Vslidated
luued By _________________ _
PERMIT VALIDATION