HomeMy WebLinkAbout2271 CAMEO RD; ; SE658025; PermitCITY OF CARLSBAD
BUILDING DEPARTMENT
SEWER
PERMIT - APPLICATION
FOR APPLICANT TO FILL IN
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO.
— —
DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ S3.OO
SEPTIC TANK, SEEPAGE PIT OR
PITS @ $5.OO
OVERFLOW SEEPAGE P
CESSPOOL, DRYWELL.
T, DRAINFIELD EXTN..
MANHOLE @ $5.OO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $I.5O
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER @ $1.5O
ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2.OO
@ $
OWNER'S
AUTHORIZATION
PERMIT S
TOTAL FEE
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i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD-
ING TO THE PUBLIC SEWER.
SIGNED THIS
OWNER OROWNER'S AGENT
DAY OF
ADDRESS
1 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,
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS-
BAD AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL
OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP-
ERTY. _ /-- \ r\ ^ /"-i s*\ A
SIGNATURE / , -, '
OF PERMITTEEV_A_^i.
CONNECTION DATA
Lateral Charge Computation
30' H., 10' V.
Add. Horiz.
Add. Vert.
Total Construction Cost __
10% Service Charge
Lat.
Total Lateral Charge
Logged in Plat:
LINE COST DATA
A. D. & Assmt. No.
LINE COST:
C. C. @_yC_ / dwelling
P. S. @ / dwelling
OTHER „_
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
St.NORTH
ENGINEERING SEWER DEPT.
Signed I Signed
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By .—-
PERMIT VALIDATION